Download Philadelphia EMA Integrated HIV Prevention and Care Plan

Philadelphia EMA
Integrated HIV
Prevention and Care
Plan
Prepared for: Philadelphia Ryan White Part A Planning Council and HIV
Prevention Planning Group
OFFICE OF HIV PLANNING | 2017-2021
0
Acknowledgements
Thanks to all the stakeholders and community members who provided data, insight, and knowledge that
made this integrated plan possible.
Special thanks to:
Philadelphia EMA Part A Ryan White Planning Council
Philadelphia HIV Prevention Planning Group
Philadelphia Department of Public Health, AIDS Activities Coordinating Office
Pennsylvania Department of Health
New Jersey Department of Public Health
Matthew McClain
Document written and edited by: Mari Ross Russell, Briana Morgan, and Nicole Johns of the Office of
HIV Planning
Copy editing by: Jennifer Hayes
Document layout and formatting by: Mari Ross Russell
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Table of Contents
Introduction .................................................................................................................................................. 6
Section I: Statewide Coordinated Statement of Need/Needs Assessment……………………………………………….8
A. Epidemiologic Overview ........................................................................................................................... 8
a.
Geographical region of the EMA ....................................................................................................... 9
b.
Socio-demographic characteristics ................................................................................................... 9
Race and Ethnicity ............................................................................................................................... 10
Poverty and Income ............................................................................................................................ 10
Education ............................................................................................................................................ 11
Employment ........................................................................................................................................ 12
Insurance ............................................................................................................................................. 12
c.
HIV/AIDS .......................................................................................................................................... 13
Deaths ..................................................................................................................................................... 16
Emerging Populations: New HIV Cases versus Prevalence ..................................................................... 17
Special Populations ................................................................................................................................. 17
Gay, Bisexual, and Other Men Who Have Sex with Men of All Races and Ethnicities........................ 18
Black Women and Men ....................................................................................................................... 18
Latino Men and Women ..................................................................................................................... 18
People Who Inject Drugs .................................................................................................................... 18
Youth Aged 13 – 24 ............................................................................................................................. 19
Transgender Women .......................................................................................................................... 19
Pregnant Women ................................................................................................................................ 20
d.
Indicators of HIV Risk....................................................................................................................... 20
Mental Health ..................................................................................................................................... 20
Substance Use ..................................................................................................................................... 20
Sexual Behaviors ................................................................................................................................. 22
Teen Pregnancies ................................................................................................................................ 22
Prenatal Care....................................................................................................................................... 22
Sexually Transmitted Infections .......................................................................................................... 23
Incarceration ....................................................................................................................................... 23
Housing ............................................................................................................................................... 24
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B. HIV Care Continuum ............................................................................................................................... 26
a.
HIV Care Continuum ....................................................................................................................... 26
HIV Care Continuum Definitions ......................................................................................................... 26
Engagement in Care Comparison............................................................................................................ 27
b.
Disparities along the Continuum .................................................................................................... 28
HIV Diagnosis ...................................................................................................................................... 28
Concurrent Diagnosis of HIV/AIDS ...................................................................................................... 28
Living with HIV/AIDS ........................................................................................................................... 29
In Care ................................................................................................................................................. 29
Retained in Care .................................................................................................................................. 30
On ART ................................................................................................................................................ 30
Viral Suppression ................................................................................................................................ 30
c.
Continuum Use in Planning............................................................................................................. 31
C. Financial and Human Resources Inventory............................................................................................. 32
a.
Funding Sources and Services, Actual for 2015 and Anticipated for 2016 ..................................... 33
b.
Work Force Capacity ....................................................................................................................... 36
c.
Coordination of HIV Prevention, Care and Treatment Services and Funding Sources ................... 38
d.
Efforts to identify and secure needed services............................................................................... 38
Housing ............................................................................................................................................... 38
Health Insurance Cost-Sharing ............................................................................................................ 39
D. Assessing Needs, Gaps, and Barriers ...................................................................................................... 40
a.
Needs Assessment Process ............................................................................................................. 40
OHP Needs Assessment Activities....................................................................................................... 40
PDPH and National Data Sources ........................................................................................................ 42
b.
Identified Service Needs of PLWH and Those at Most Risk ............................................................ 42
High Quality HIV and Primary Care ..................................................................................................... 43
Medical and Non-Medical Case Management.................................................................................... 44
Transportation .................................................................................................................................... 44
Dental Care ......................................................................................................................................... 45
Mental Health ..................................................................................................................................... 45
Substance Use ..................................................................................................................................... 46
PLWH and substance use .................................................................................................................... 47
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Housing insecurity and homelessness ................................................................................................ 48
Risk behaviors associated with insecure housing ............................................................................... 49
Sex Education ...................................................................................................................................... 49
c.
Identified Barriers to HIV Prevention and Care Services ................................................................ 51
Social and structural barriers .............................................................................................................. 51
Legislative and Policy Barriers............................................................................................................. 52
Health Department Barriers ............................................................................................................... 53
Program Barriers ................................................................................................................................. 53
Service Provider Barriers..................................................................................................................... 53
Client Barriers...................................................................................................................................... 54
E: Data Access, Sources, and Systems......................................................................................................... 55
a.
Data Sources and Systems .............................................................................................................. 55
PDPH and National Data Sources ........................................................................................................ 55
OHP Research...................................................................................................................................... 56
b.
Policy Facilitators and Challenges ................................................................................................... 56
c.
Unavailable Data ............................................................................................................................. 57
Section II: Integrated HIV Prevention and Care Plan………………………………………………………………………………58
A: Goals and Objectives .............................................................................................................................. 58
Goal 1: Reduce new HIV infections ......................................................................................................... 59
Objective 1.1: Increase the proportion of people who know their HIV status ................................... 59
Objective 1.2: Reduce the number of new HIV infections.................................................................. 60
Anticipated challenges and barriers to Goal 1 include: .......................................................................... 64
Resources ............................................................................................................................................ 64
Goal 2: Increase access to care and improve health outcomes for people living with HIV .................... 65
Objective 2.1: Increase the percentage of newly diagnosed persons linked to HIV medical care
within 30 days of diagnosis. ................................................................................................................ 65
Objective 2.2: Increase the percentage of people with diagnosed HIV infection retained in care. ... 66
Objective 2.3: Increase the percentage of people with diagnosed HIV infection who are virally
suppressed. ......................................................................................................................................... 68
Objective 2.4: Increase the percentage of PLWH retained in HIV care who are stably housed......... 69
Anticipated challenges and barriers to Goal 2 include: ...................................................................... 70
Resources……………………………………………………………………..……………………………………………………………….70
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Goal 3: Reduce HIV-related disparities and health inequities ................................................................ 71
Objective 3.1: Reduce HIV related disparities in new diagnoses among high-risk populations. ........ 71
Objective 3.2: Reduce disparities in viral suppression........................................................................ 73
Anticipated challenges and barriers to goal 3: ................................................................................... 75
Resources ............................................................................................................................................ 75
Goal 4: Achieve a more coordinated response to the HIV epidemic...................................................... 76
Objective 4.1: Support collaboration, communication and coordination across all sectors. ............. 76
Objective 4.2: Facilitate collaboration, communication and coordination in integrated planning
activities. ............................................................................................................................................. 77
Anticipated challenges and barriers to Goal 4 include: ...................................................................... 79
Resources ............................................................................................................................................ 79
B: Collaborations, Partnerships and Stakeholder Involvement .................................................................. 80
a.
Stakeholder Contributions .............................................................................................................. 80
b.
Gaps in Stakeholder Participation................................................................................................... 81
c.
Letter of Concurrence ..................................................................................................................... 81
C: People Living with HIV and Community Engagement ............................................................................ 82
a.
Community participation in plan development .............................................................................. 82
b.
PLWH and community participation in plan development ............................................................. 82
c.
Methods for community engagement ............................................................................................ 82
d.
Community insights and solutions .................................................................................................. 83
Section III: Monitoring and Improvement………………………………………..…………………………………………………….84
Process for updating planning bodies and stakeholders ........................................................................ 84
Monitoring and evaluation of goals and objectives ............................................................................... 86
Strategy to use surveillance and program data to improve health outcomes ....................................... 88
Appendix A: List of Public and Privately funded Provider Agencies and Work Force Capacity Tables..……94
Appendix B: Letters of Concurrence…………………………………………………………………………………………………….126
Appendix C: Glossary…………………………………………………………………………………………………………………………..128
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Introduction
The following document is the sum of the work of the Philadelphia Eligible Metropolitan Area (EMA)
Ryan White Part A Planning Council (RWPC), the Philadelphia HIV Prevention Planning Group (HPG), the
Philadelphia Department of Public Health’s AIDS Activities Coordinating Office (PDPH’s AACO), and the
Office of HIV Planning (OHP) 1. This plan includes and draws upon epidemiologic data, community input,
focus groups, surveys, geographic analysis, and historical and social context. While firmly rooted in the
federal guidance for integrated care and prevention plans, it expands upon many elements in order to
provide a more complete assessment of the HIV system in the nine-county Philadelphia region. In
accordance with the guidance, AACO and OHP staff actively participate in the Pennsylvania statewide
HIV planning process, while a representative from the Pennsylvania Department of Health participates
in the Philadelphia EMA planning process. In addition, OHP staff have attended New Jersey HIV Planning
Group meetings, and representatives from the New Jersey HIV Planning Group and the New Jersey
Department of Public Health sit on the Philadelphia EMA RWPC. Furthermore, this plan provides for
ongoing coordination and future collaboration with both the Pennsylvania Department of Health and
the New Jersey Department of Public Health. This document also includes multiple needs assessment
activities, which meets and exceeds the guidance’s requirements of CDC-funded recipients.
1
Editor’s note: Throughout this document “PDPH” will refer to the AIDS Activities Coordinating Office, except
where “AACO” is used to distinguish between specific AACO activities as recipient of the Ryan White Part A grant
for the EMA and activities of other divisions and departments of PDPH. “Recipient” is also used to refer to AACO
when discussing Ryan White Part A program activities and monitoring.
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Section I: Statewide
Coordinated Statement
of Need/Needs
Assessment
A. Epidemiologic Overview
The following section is based on tables and figures from the Integrated Epidemiologic Profile for
HIV/AIDS Prevention and Care Planning, Philadelphia Eligible Metropolitan Area (2015). 2 When possible,
the information from the original profile has been updated for this plan. Both the original profile and the
following section combine data from numerous sources, and they have been developed in accordance
with the 2014 Integrated Guidelines for Developing Epidemiologic Profiles. 3 The complete epidemiologic
profile describes the general population of the EMA, risk indicators, characteristics of the local HIV
epidemic, unmet need and service utilization. The epidemiologic overview below includes selected
highlights from the full profile, augmented by further information and context from the Philadelphia
Department of Public Health (PDPH).
Office of HIV Planning. (2015). Integrated Epidemiologic Profile for HIV/AIDS Prevention and Care Planning, Philadelphia
Eligible Metropolitan Area. Retrieved from http://www.hivphilly.org/Documents/EpiProfile/2015Epi.pdf.
3 Centers for Disease Control and Prevention and Health Resources and Services Administration. (2014). Integrated Guidance
for Developing Epidemiologic Profiles: HIV Prevention and Ryan White HIV/AIDS Programs Planning. Atlanta, Georgia: Centers
for Disease Control and Prevention.
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a. Geographical Region of the EMA
The Health Resources and Services Administration (HRSA) defines the Philadelphia Eligible Metropolitan
Area (EMA) as Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties in Pennsylvania, and
Burlington, Camden, Gloucester, and Salem Counties in New Jersey.
The Philadelphia Eligible Metropolitan Area
Bucks
Montgomery
Philadelphia
Chester
Delaware
Burlington
Camden
Gloucester
Salem
b. Socio-demographic Characteristics
The Philadelphia area spans two states and encompasses urban, suburban, and rural areas.
Demographic makeup varies greatly by area, from 86% non-Hispanic White in Bucks County to the
majority-minority City of Philadelphia. Chester County is the highest-income county in Pennsylvania and
one of the wealthiest counties in the United States, while Philadelphia has the highest rate of deep
poverty of any major city in the country. These demographic variations within the region also translate
to variations in at-risk populations and people living with HIV/AIDS throughout the area.
In 2015, the nine-county Philadelphia metropolitan area had 5,410,714 residents. 4 Of these,
Philadelphia had 1,567,442 residents. In the suburban Pennsylvania counties, Bucks had 627,367
residents, Chester had 515,939 residents, Delaware had 563,894 residents, and Montgomery had
U.S. Census Bureau. (2015). PEPANNRES Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2015 [Data].
2015 Population Estimates. Retrieved from http://factfinder.census.gov/.
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819,264 residents, totaling 2,526,464 suburban Pennsylvania residents. Among the Southern New Jersey
counties, Burlington had 450,226 residents, Camden had 510,923 residents, Gloucester had 291,479
residents, and Salem had 64,180 residents, totaling 1,316,808 Southern New Jersey residents.
Race and Ethnicity
Racial and ethnic composition varies widely across the Philadelphia area. In 2014, 64% of the EMA’s
population was non-Hispanic White, 20% was non-Hispanic Black, 5% was non-Hispanic Asian, and 9%
was Hispanic (all races). 5 Yet, in Philadelphia, only 36% of the general population was White, while 42%
was Black, 7% was Asian, and 13% was Hispanic. Camden County was 58% White, 18% Black, 5% Asian,
and 15% Hispanic. Bucks County was 86% White, 6% Black, 4% Asian, and 7% Hispanic. Even within these
counties, racial and ethnic distribution was uneven. In each county, there are areas in which residents
are predominantly of a single racial/ethnic group. This is particularly stark in Philadelphia, where the
sheer population makes these patterns more evident. In addition, according to a 2015 analysis,
Philadelphia is the fourth-most segregated city in the United States. 6 This is illustrated through the
Philadelphia county map on the following page.
Poverty and Income
As with many metropolitan areas, income varied throughout the Philadelphia EMA. By county, the
highest median household income was found in Chester County ($86,093 in 2014), while median
household income in Coatesville (a city within Chester County) was only $35,601. 7 This is even lower
than Philadelphia’s median household income of $37,460. In Camden County, the median household
income was $61,842, but in the City of Camden, median household income was only $26,201. Median
individual income by gender varied from county to county within the EMA, although the wage gap was
largest in the county with the highest income (Chester) and smallest in the county with the lowest
income (Philadelphia).
Less than 6% of people in Burlington County lived below the poverty level, while over 26% of
Philadelphia lived in poverty. In every county, poverty is particularly concentrated in specific areas,
although it is the most widespread in Philadelphia. The map on the next page illustrates where White,
Black, Asian, and Hispanic residents in poverty live throughout the city. As seen below, Hispanics in
poverty are concentrated in lower Northeast Philadelphia, while Blacks in poverty are concentrated in
North, West, and Southwest Philadelphia. Whites and Asians in poverty are slightly more distributed:
poor Whites are found in South, near West, upper Northeast, and lower Northwest Philadelphia, while
poor Asians are concentrated in pockets in South Philadelphia, upper North Philadelphia, and the
Northeast.
U.S. Census Bureau. (2014). DP05 Demographic and Housing Estimates [Data]. 2010-2014 American Community Survey 5-Year
Estimates. Retrieved from http://factfinder.census.gov/.
6 Silver, Nate. (2015). The Most Diverse Cities Are Often The Most Segregated. Retrieved from
http://fivethirtyeight.com/features/the-most-diverse-cities-are-often-the-most-segregated/.
7 U.S. Census Bureau. (2014). S1901 Income in the Past 12 Months (in 2014 Inflation-Adjusted Dollars) [Data]. 2010-2014
American Community Survey 5-Year Estimates. Retrieved from http://factfinder.census.gov/.
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People in Philadelphia Living At or Below Poverty, by Race/Ethnicity (2014)
Author: Mari Ross-Russell, Office of HIV Planning
Maps describing the racial/ethnic distribution of people in poverty are available for each of the nine
counties online. While these maps provide context on all people below poverty, it is notable that 12.5%
of Philadelphia lives in deep poverty (defined as less than half of the federal poverty level). This is the
highest deep poverty rate of the ten largest cities in the United States. The City of Camden had an even
higher deep poverty rate in 2014, with 20.4% of residents living in deep poverty.
Education
In every county and both states of the EMA, poverty rates decreased for both men and women as
educational attainment increased. In 2014, the poverty rate for men within the EMA with at least a
bachelor’s degree was 3.4%, and 4.2% for women. 8 By contrast, the poverty rate among men who have
not completed high school (or a GED program) was 24.4%; for women, this rate was 31.3%. In the City of
Philadelphia, women without a high school education had a poverty rate of 41.9%, while men without a
U.S. Census Bureau. (2014). B17003 Poverty Status in the Past 12 Months of Individuals by Sex by Educational Attainment
[Data]. 2010-2014 American Community Survey 5-Year Estimates. Retrieved from http://factfinder.census.gov/.
8
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high school education had a poverty rate of 33.2%. As seen below, education level is also linked to
unemployment.
Employment
In Philadelphia, 14.9% of residents in the labor force were unemployed in 2014. 9 Unemployment rates
varied significantly throughout the nine-county area; for example, the unemployment rate in Chester
County was only 6.3%. As with poverty, unemployment rates also varied within counties: while Camden
County residents in the workforce experienced 11.4% unemployment, 22% of Camden City’s workforce
was unemployed.
Unemployment also varied by race/ethnicity: 10.6% of Whites in Philadelphia’s labor force were
unemployed, while 19.9% of Blacks and 19.9% of Hispanics (any race) were unemployed. In nearly every
county in the nine-county area, Blacks and Hispanics experienced a higher rate of unemployment than
Whites – with the exception of Gloucester County, where unemployment among Hispanics was slightly
lower than unemployment among Whites.
As seen with the poverty rate by education level, the rate of unemployment went down as the level of
education increased. Philadelphians aged 25 – 64 who had less than a high school education saw an
unemployment rate of 23.2%, while Philadelphians with at least a bachelor’s degree had a 5.1%
unemployment rate. Again, this was true of every county in the nine-county Philadelphia EMA.
Insurance
New Jersey fully expanded Medicaid in 2014. Pennsylvania had limited Medicaid expansion in 2014
under a program called Healthy PA but fully expanded Medicaid in 2015. The most recent insurance
coverage estimates from the American Community Survey are 1-year estimates for 2014, so these will
not completely capture the impact of Medicaid expansion in New Jersey in 2014, nor the full expansion
in Pennsylvania that did not occur until 2015.
In 2014, 12.6% of Philadelphians were uninsured. 10 Uninsured rates in the suburban Pennsylvania
counties ranged from 5.1% in Montgomery County to 7.9% in Delaware County. In the New Jersey
counties, uninsured rates ranged from 6.1% in Burlington and Gloucester Counties to 11.1% in Camden
County.
By contrast, in 2010, 14.9% of Philadelphia was uninsured. In the suburban Pennsylvania Counties,
uninsured rates went from 6.7% in Bucks County to 9.2% in Delaware County. Uninsured rates in the
four New Jersey Counties ranged from 7.4% in Burlington County to 12.4% in Camden County. In fact,
the percentage of people who were insured increased across all counties in the EMA between 2010 and
2014.
For all counties, uninsured rates were significantly higher among people who were unemployed. In all
but one county, the uninsured rate among people who were unemployed was at least three times as
U.S. Census Bureau. (2014). S2301 Employment Status [Data]. 2010-2014 American Community Survey 5-Year Estimates.
Retrieved from http://factfinder.census.gov/.
10 U.S. Census Bureau. (2014). S2701 Health Insurance Coverage Status [Data]. 2010-2014 American Community Survey 5-Year
Estimates. Retrieved from http://factfinder.census.gov/.
9
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high as the uninsured rate in the general population. (In Gloucester County, people who were
unemployed experienced 2.83 times the uninsured rate of the general population.)
In all counties, men were more likely to be uninsured than women. In all counties but Salem County, the
uninsured rate was higher among 19 to 25 year olds than the general population. In every county where
data was available, the uninsured rate among Hispanics was much higher than among non-Hispanic
Whites, ranging from 2.2 times as high in Gloucester and Philadelphia Counties to 8.2 times as high in
Chester County.
c. HIV/AIDS
As of 2014, an estimated 27,121 people were living with HIV/AIDS in the nine-county Philadelphia EMA.
Of these, 11,843 (44%) were living with HIV (non-AIDS), while another 15,278 (56%) were living with
AIDS. Between 2012 and 2014, there were 3,292 new HIV/AIDS diagnoses, of which 2,120 were
diagnosed with HIV, and 1,172 were diagnosed with AIDS. The total number of people living with
HIV/AIDS in the region has been growing over time, as new diagnoses are outpacing deaths among
people with HIV/AIDS.
Newly Diagnosed and Prevalent HIV and AIDS Cases, Philadelphia EMA
2012
2013
2014
HIV not AIDS
New
Diagnoses
712
Prevalence
11,244
New
Diagnoses
729
Prevalence
11,508
New
Diagnoses
679
Prevalence
11,843
AIDS
470
15,739
393
15,456
309
15,278
With 1.3% of residents living with HIV, the City of Philadelphia has a generalized epidemic, defined as a
prevalence rate of 1% or higher. Prevalence for the entire nine-county EMA is about 0.3%. This
prevalence rate varies by population, as displayed on the following page. When reviewing HIV
prevalence by race/ethnicity and gender, Black men have the highest rates, followed by Hispanic men,
Black women, and Hispanic women.
13
EMA-wide HIV Prevalance Rates Among Selected Sub-Populations, 2014
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Black Males
Hispanic Males
White Males
Black Females
Hispanic Females
As with other characteristics within the nine-county Philadelphia EMA, HIV/AIDS varies within the area.
For planning purposes, the nine counties in the Philadelphia EMA are broken out into three smaller
regions: the City of Philadelphia, the four suburban Pennsylvania Counties (including Bucks, Chester,
Delaware, and Montgomery), and the four New Jersey Counties (Burlington, Camden, Gloucester, and
Salem). As seen previously, these smaller regions vary greatly by demographics and other
characteristics.
The next table displays characteristics of people who were newly diagnosed with HIV from 2012 – 2014.
Race/ethnicity, gender, age, and mode of transmission vary by region. In Philadelphia, a higher
percentage of new diagnoses were among youth, females, non-Hispanic Blacks, and men who have sex
with men than in the rest of the EMA. In the suburban PA counties, a higher percentage of new cases
were among non-Hispanic Whites, men, and people 50 and older. In the New Jersey counties, a higher
percentage was seen among non-Hispanic Whites, Hispanics, women, and people over 30.
14
This information is useful for identifying emerging regional trends within the nine-county area. Specific
populations will be discussed later in this section.
Newly Diagnosed HIV (Non-AIDS) for 2012-2014, Philadelphia EMA
EMA
Phila
PA
Total
EMA
N=1,433
N=391
N=2,120
%
%
%
Race/Ethnicity
White, non-Hispanic
Black, non-Hispanic
Hispanic
Asian/Pacific Islander
American Indian/Alaskan Native
Multi-Race
Unknown
Gender
Male
Female
Age
<13 years
13 - 19 years
20-24 years
25-29 years
30-39 years
40-49 years
50+ years
Mode of Transmission
Men who have sex with men (MSM)
Injection drug users (IDU)
MSM/IDU
Heterosexuals
Other/hemophilia/blood transfusion
Perinatal exposures
Risk not reported or identified
15
NJ
N=224
%
409
1,335
307
30
9
24
6
19.3
63.0
14.5
1.4
0.4
1.1
0.3
13.0
70.1
14.1
1.6
0.6
0.6
0.0
38.9
45.3
10.0
1.8
0.3
3.8
0.0
23.6
52.0
22.3
0.0
0.0
0.0
2.0
1,641
479
76.2
23.8
70.9
21.7
79.0
21.0
70.9
29.1
12
126
442
365
435
370
370
0.6
5.9
20.8
17.2
20.5
17.5
17.5
0.1
6.8
22.7
18.1
19.7
16.7
15.9
1.3
4.9
17.9
15.6
20.5
17.9
22.0
1.7
3.4
15.5
15.2
24.7
20.6
18.9
1,048
140
24
786
0
15
107
49.4
6.6
1.1
37.1
0.0
0.7
5.0
52.1
6.8
1.2
37.5
0.0
0.3
2.1
49.9
5.1
1.3
33.5
0.0
1.3
9.0
35.8
7.8
0.7
39.9
0.0
1.7
14.2
Deaths
Within the Philadelphia Eligible Metropolitan Area, deaths among people with HIV/AIDS have been on
the decline. This is true for both deaths by any cause among people with HIV and deaths attributed to
HIV-related illness. The line graphs below show the decline in deaths for Philadelphia only because data
for HIV-related deaths are limited in the EMA in recent years due to small numbers of deaths in many of
the counties.
As seen in the first graph, all deaths among people with HIV/AIDS and deaths due to HIV disease in
Philadelphia have declined from 2008 to 2013. The second graph shows deaths due to HIV disease from
1987 – 2014. 11 12 Deaths attributed to HIV disease in Philadelphia peaked in 1995, when there were 652
deaths. There were 82 deaths attributed to HIV-related illness in 2014.
HIV Deaths in Philadelphia, 2008 - 2014
600
524
511
546
473
500
432
400
393
300
200
156
134
128
120
100
131
90
82
0
2008
2009
2010
Deaths Due to HIV Disease
2011
2012
2013
2014
All Deaths Among People with HIV
11 Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Underlying Cause of Death 19992014 on CDC WONDER Online Database [Data]. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from
data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved from
http://wonder.cdc.gov/ucd-icd10.html.
12 Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Compressed Mortality File 19791998. CDC WONDER Online Database, compiled from Compressed Mortality File CMF 1968-1988, Series 20, No. 2A, 2000 and
CMF 1989-1998, Series 20, No. 2E, 2003 [Data]. Retrieved from http://wonder.cdc.gov/cmf-icd9.html.
16
Philadelphia Deaths Attributed to HIV Disease, 1987 - 2014
700
600
500
400
300
200
100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
0
Emerging Populations: New HIV Cases versus Prevalence
The epidemic in the nine-county Philadelphia EMA is complex and has changed over time. There are a
significant number of long-term survivors who have been living with HIV for 10, 15, 20+ years, and the
populations that are acquiring HIV have shifted over time. Consequently, the people who are currently
living with HIV/AIDS within the nine-county area are demographically very different from the people
who are just being diagnosed with HIV/AIDS. Nearly a quarter (23%) of PLWH in the EMA likely were
exposed to HIV through injection drug use, but less than 7% of new diagnoses were among people who
inject drugs from 2012 – 2014. This decrease in new cases among people who inject drugs is commonly
attributed to Philadelphia’s syringe exchange program. Meanwhile, people aged 13 - 24 make up only
4% of total people living with HIV/AIDS in the EMA, but represented 26.7% of new HIV/AIDS diagnoses
from 2012 – 2014. This demonstrates an emerging population for new HIV infections. Still, 61% of PLWH
in the EMA are 45 and older, indicating that there is a significant aging population among people who
are already HIV-positive. These differences indicate that different strategies may be needed for people
who are linking to HIV care for the first time and those who the system is attempting to retain in care.
Special Populations
The target populations provided in the National HIV/AIDS Strategy are helpful in identifying those
people most at risk of acquiring HIV or being loosely engaged in HIV care. 13 However, the Philadelphia
EMA’s diversity means that the target populations represent the majority of the EMA’s general
population. For example, combined population estimates for Black women and men, Latino men and
women, and youth 13 – 24 total over 2 million EMA residents. Within the City of Philadelphia, Black
women and men make up 42% of the population, and Latino men and women make up 13% of the
population. These two target populations alone comprise 55% of the city’s 1.56 million inhabitants.
13 The White House, Office of National AIDS Policy (2015). National HIV/AIDS Strategy for the United States: Updated to 2020.
Retrieved from https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf.
17
Therefore, while each National HIV/AIDS Strategy population is addressed through Philadelphia EMA
goals (with the exception of people in the Southern United States), some of the populations have been
stratified.
Gay, Bisexual, and Other Men Who Have Sex with Men of All Races and Ethnicities
PDPH estimates that 5% of men in Philadelphia are gay, bisexual, or other men who have sex with men
(MSM). Yet, MSM make up over one-third (36%) of people living with HIV/AIDS within the Philadelphia
EMA. In 2014, one-third of new AIDS cases were among MSM, and over half of new HIV (non-AIDS) cases
were among MSM in Philadelphia. This indicates that MSM are emerging as a significant at-risk
population. Philadelphia surveillance data from 2014 suggests that 33.1% of the entire Black MSM
population is living with HIV/AIDS and aware of their status. Meanwhile, incidence has increased among
MSM aged 24 and under: this subpopulation accounted for nearly one-third (32.3%) of all newly
diagnosed HIV (non-AIDS) for the EMA in 2014. EMA data on HIV diagnoses indicates that the majority of
these infections are among Black MSM, since 60.7% of new MSM HIV (non-AIDS) diagnoses between
2012 and 2014 were among Black MSM. In Philadelphia’s National HIV Behavioral Surveillance (NHBS)
project, 27.5% of MSM tested positive for HIV. PDPH estimates that 13.2% of HIV-positive MSM are not
aware of their status, which is higher than the citywide estimate of 10.4% undiagnosed HIV infections.
Furthermore, there was a 19% increase in the number of new HIV diagnoses in MSM in Philadelphia
between 2006 and 2012, but a 55% increase in the estimated number of infections among MSM over
that time. This suggests that there is a growing population of MSM who are unaware of their HIV status.
Black Women and Men
Black women and men make up 20% of the EMA-wide population but 58% of people living with
HIV/AIDS in the Philadelphia EMA. In every part of the EMA, the percentage of new HIV infections
among Blacks is significantly higher than the percentage of Blacks in the general population. In 2014,
67% of all new diagnoses in Philadelphia were among Blacks; of these, 45% were attributed to
heterosexual contact, and 49% were attributed to male-to-male sexual contact. Only three percent were
attributed to injection drug use.
Latino Men and Women
Latino men and women make up 9% of the EMA-wide population but 14% of people living with HIV/AIDS
within the EMA. In Philadelphia, 14.5% of new diagnoses were among Latinos in 2014. Of these new
diagnoses, 47% were attributed to male-to-male sexual contact, 41% were attributed to heterosexual
contact, and 12% were attributed to injection drug use.
People Who Inject Drugs
While injection drug use was a leading exposure category early in the HIV/AIDS epidemic, new infections
through injection drug use have declined considerably. Nearly one-quarter (23%) of people living with
HIV/AIDS in the Philadelphia EMA were exposed to HIV through injection drug use, but only about 5% of
new HIV diagnoses in 2014 occurred among people who inject drugs. According to Philadelphia’s
National HIV Behavioral Surveillance (NHBS) project, over two-thirds of all people who inject drugs in
Philadelphia access syringe supplies through the locally-funded syringe exchange program. This program
is widely attributed as the cause of declining HIV infections among people who inject drugs. In addition
18
to syringe exchange, this program provides harm reduction services like on-site HIV counseling and
testing and referral to medical care. Furthermore, the NHBS project demonstrated that people who
accessed the syringe exchange program had much higher rates of HIV testing than the general
population of people who inject drugs (over 90%).
Youth Aged 13 – 24
Youth aged 15 – 24 make up about 15% of people living in the nine-county EMA. 14 Yet, a
disproportionate number of new HIV diagnoses have been among youth in recent years. From 2012 –
2014, 29.5% of new diagnoses in Philadelphia were among youth aged 13 – 24. This figure was 22.8% in
the PA counties and 18.9% in the New Jersey counties. Estimated new infections in 2013 were even
higher for this group: people aged 13 – 24 accounted for 44% of these estimated new infections.
Transgender Women
Data on transgender women in the general population is very limited. In 2016, the Williams Institute
estimated that 0.6% (about 1.4 million) of adults in the United States were transgender, based on survey
data. 15 In 2015, the Census Bureau more conservatively identified 89,667 transgender individuals who
were alive in 2010, based on official name and sex changes in Social Security Administration records. 16
Assuming that the more inclusive William Institute estimate similarly applies to the Philadelphia EMA,
we can crudely estimate that there may be 32,464 people who are transgender in the EMA.
There is information available about transgender women living with HIV/AIDS in Philadelphia, although
transgender data is not available for the surrounding counties. Surveillance data on transgender persons
is not uniformly collected by testing or medical providers. In addition, some transgender people may not
identify as transgender or may be gender non-conforming. Philadelphia HIV surveillance data did not
have the capacity to collect current gender until 2009 (only sex at birth was captured prior to this). This
has resulted in incomplete reporting of transgender persons living with HIV in Philadelphia. Improving
this data is a high priority for the PDPH. The 2014 HIV Care Continuum (see Section B) was based on 140
transgender persons living with HIV in Philadelphia. Of these, 127 identified as trans women, 6 as trans
men and, 7 identified another way. Of transgender persons living with HIV in Philadelphia, 72% were
Black, 17% were Hispanic, and 6% were White. Nearly three-quarters were over the age of 30. For
transgender persons living with HIV, most reported sexual risk as their mode of transmission (80%), with
another 9% reporting injection drug use, and another 11% reporting both sexual and injection drug use
as their risk.
U.S. Census Bureau (2015). S0101 Age and Sex [Data]. 2010-2014 American Community Survey 5-Year Estimates. Retrieved
from http://factfinder.census.gov/. The differences in age group between the section header and this sentence is not an error,
but reflective of data reporting differences.
15 Flores, A.R., Herman, J.L., Gates, G.J., Brown, T.N.T. (2016). How many adults identify as transgender in the United States?
The Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-asTransgender-in-the-United-States.pdf
16 Harris, Benjamin Cerf (2015). Likely Transgender Individuals in U.S. Federal Administrative Records and the 2010 Census. U.S.
Census Bureau. Retrieved from
http://www.census.gov/srd/carra/15_03_Likely_Transgender_Individuals_in_ARs_and_2010Census.pdf.
14
19
Pregnant Women
Prenatal care is a particular challenge in Philadelphia, where an average of 31% of mothers do not
receive adequate prenatal care. According to PDPH data, 3% of HIV-positive women of childbearing age
in the EMA become pregnant and deliver a baby each year. After extensive analysis, PDPH found that
25% of HIV-positive women who gave birth between 2005 and 2013 received their HIV diagnosis during
pregnancy. Of these women, only 39% received adequate prenatal care during pregnancy, and 52% had
achieved viral suppression at the time of delivery. This indicates an even lower receipt of appropriate
prenatal care than seen in the general population (69%).
d. Indicators of HIV Risk
Mental Health
According to the 2010 – 2012 National Survey on Drug Use and Health (NSDUH), 4.91% of Philadelphians
had a serious mental illness in the year before the survey, while 18.46% had any mental illness diagnosis
during that time. 17 These figures were 3.47% and 16.88% in Southeastern Pennsylvania, and 3.4% and
16.66% in Southern New Jersey. 18 Furthermore, the NSDUH estimated that 7.95% of Philadelphians,
6.95% of Southeastern Pennsylvanians, and 6.46% of Southern New Jerseyans had a major depressive
incident in the previous year.
Among people with HIV/AIDS, mental illness diagnoses were more common than in the general
population. The 2009 – 2010 Medical Monitoring Project in Philadelphia found that 49% of people with
HIV/AIDS had a mental health diagnosis. This indicates that approximately 13,289 people with HIV/AIDS
in the Philadelphia EMA may have some form of mental illness.
Substance Use
The 2010 – 2012 National Survey on Drug Use and Health estimated that 28.44% of Philadelphians binge
drank in the month before the survey, as compared with 25.75% of Southeastern Pennsylvanians and
22.87% of people in Southern New Jersey.
In Philadelphia, the 2010 - 2012 NSDUH estimated that 13.13% of residents used an illicit substance in
the month before the survey, and that 4.2% of Philadelphians used an illicit substance other than
marijuana in the previous month. In the surrounding PA counties, 7.81% of residents were estimated to
have used any substance in the month before the survey, while 2.83% of residents were estimated to
have used an illicit substance other than marijuana. In Southern New Jersey (a NSDUH region that
includes the four EMA counties as well as three other counties), 8.82% of residents were estimated to
have used an illicit drug in the past month, while 3.52% of residents were estimated to have used an
illicit drug other than marijuana. The NSDUH estimated that 4.99% of Philadelphians, 4.7% of Southern
United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (2010
– 2012). Pennsylvania: 2010 – 2012 National Survey on Drug Use and Health substate estimates. Retrieved from
http://www.samhsa.gov/data/sites/default/files/substate2k12-StateTabs/NSDUHsubstateStateTabsPA2012.htm.
18 United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (2010
– 2012). New Jersey: 2010 – 2012 National Survey on Drug Use and Health substate estimates. Retrieved from
http://www.samhsa.gov/data/sites/default/files/substate2k12-StateTabs/NSDUHsubstateStateTabsNJ2012.htm.
17
20
New Jerseyans, and 3.77% of Southeastern Pennsylvanians used pain relievers non-medically in the past
year.
According to the 2012 Treatment Episode Data Set - Admissions (TEDS-A), 93% of people in the
Philadelphia area who were in rehabilitation programs for injecting drugs were White. 19 Among all
Whites in rehabilitation programs, heroin was the most common primary substance, followed by
alcohol. Among Blacks and Hispanics, the most common primary substance was marijuana, followed by
alcohol. The National Survey on Drug Use and Health estimated that 3.75% of people in Philadelphia
needed but did not receive treatment for illicit drug use in the year before the survey, as compared with
2.14% of people in Southeastern Pennsylvania and 2.26% of people in Southern New Jersey.
The January 1, 2016 Morbidity and Mortality Weekly Report cited reports that there had been a sharp
increase in seizures of fentanyl in Philadelphia, which has previously been associated with increased
overdose deaths. 20 In 2014, the state of Pennsylvania ranked #8 for overdose deaths in the United
States, with 2,426 overdose deaths, a 12.9% increase over the previous year. New Jersey experienced a
3.4% decline to 1,253 deaths. Overdose death rates by county in the EMA ranged from 10.9 per 100,000
in Chester County to 29.7 per 100,000 in Gloucester County in 2013. 21
Pennsylvania law changed to allow emergency responders to carry naloxone for the purposes of
overdose reversal in November 2014. From that time until September 1, 2015, Delaware County police
reversed 84 overdoses, 29% of Pennsylvania police’s 289 overdose reversals. 22 In the first six months of
2015, Philadelphia Fire and Emergency Medical Services (EMS) administered naloxone 1,258 times. 23
Camden County police also carry naloxone, and completed their 300th overdose reversal in September
2015. However, it is impossible to know how many of these overdoses would have resulted in death.
Some types of substance use appear to be more prevalent among the EMA’s PLWH than the general
population. Data from the 2013 Medical Monitoring Project in Philadelphia showed that 14.2% of people
with HIV/AIDS who were accessing care binge drank, as compared with the 28.44% of all Philadelphians
estimated to binge drink. However, 24.2% of MMP participants used illicit substances in the previous
twelve months, while 13.13% of Philadelphians were estimated to have used an illicit substance in the
United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration.
Center for Behavioral Health Statistics and Quality (2012). Treatment Episode Data Set -- Admissions (TEDS-A). Ann Arbor, MI:
Inter-university Consortium for Political and Social Research [distributor]. Retrieved from
http://doi.org/10.3886/ICPSR35037.v1
20 R.A. Rudd, N. Aleshire, J.E. Zibbell, & R.M. Gladden (2016). Increases in Drug and Opioid Overdose Deaths – United States,
2000 -2014. Morbidity and Mortality Weekly Report, 64(50 – 51), 1378 – 1382. Retrieved from
http://www.cdc.gov/mmwr/pdf/wk/mm6450.pdf.
21 Centers for Disease Control and Prevention, National Center for Health Statistics (2015). Underlying Cause of Death 19992014 on CDC WONDER Online Database [Data]. Data are from the Multiple Cause of Death Files, 1999-2014, as compiled from
data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved from
http://wonder.cdc.gov/ucd-icd10.html.
22 Sapatkin, Don (2015, September 02). Pennsylvania police reversed 289 overdoses, state says. Philadelphia Inquirer. Retrieved
from http://articles.philly.com/2015-09-02/news/66112402_1_drug-overdoses-naloxone-narcan.
23 Delaware Valley Intelligence Center (2015). Philadelphia Narcan Administration by ZIP Code 01 January through 30 June 2015.
Retrieved from https://info.publicintelligence.net/DVIC-Narcan-2015.pdf.
19
21
month before the NSDUH. In addition, 10.7% of people with HIV/AIDS reported currently using
substances during their PDPH’s Client Services Unit intake.
Sexual Behaviors
Among adults in eight of the nine counties in the Philadelphia EMA (excluding Salem County), 121 of
4,193 Behavioral Risk Factor Surveillance Survey respondents in 2010 reported engaging in “risky
behavior” in the year before the survey. 24 Risky behavior was defined as any of the following:
intravenous drug use, sexually transmitted disease treatment, exchange of sex for money or drugs, or
anal sex without a condom in the previous year. These behaviors were reported most frequently among
people aged 25 – 34.
For the entire state of New Jersey, 29.1% of high school students surveyed in 2013 reported having sex
in the past three months, and 41.4% of sexually active students did not use a condom at their last
encounter. 25 Of all students, 12.2% reported having had at least 4 partners during their lives. In
Philadelphia, 37.3% of high school students surveyed reported having sex within the last three months,
and 42.2% of these students reported not using a condom at their last encounter. Of all students, 21.8%
reported having had at least four partners during their lives.
Teen Pregnancies
In 2014, there were 6,659 births to teen mothers in Pennsylvania and 2,223 births to teen mothers in
New Jersey. 26 Across all counties within the nine-county Philadelphia EMA, births to teen mothers
decreased from 2008 to 2012. There were an estimated 2,736 births to 15 – 19-year-old mothers in the
Philadelphia EMA in 2014 (excluding Salem County), a considerable decline from the estimated 4,362
births to teen mothers in these eight counties of the EMA in 2008.
Prenatal Care
Within Philadelphia, an average of 30.9% of pregnant mothers of received inadequate 27 prenatal care
from 2011 – 2013. 28 This figure was 37% among Black mothers and 34.8% among Hispanic mothers.
When broken out by age, 45% of mothers under the age of 20 received inadequate prenatal care. For
the entire state of Pennsylvania, 18.4% of all mothers received inadequate prenatal care, compared with
30.1% among mothers under the age of 20, 30.2% among Black mothers, and 27.4% among Hispanic
mothers. The most recent data available on prenatal care for the state of New Jersey is from 2008 –
2010. Statewide, an average of 14.9% of all mothers received inadequate prenatal care, as compared
with 33.1% of mothers under the age of 20, 26.3% of Black mothers, and 20.4% of Hispanic mothers. In
Centers for Disease Control and Prevention (2010). Behavioral Risk Factor Surveillance System Survey Data [Data]. Atlanta,
Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from
http://www.cdc.gov/brfss/annual_data/annual_2010.htm.
25 Centers for Disease Control and Prevention (2013). 1991-2013 High School Youth Risk Behavior Survey Data [Data]. Atlanta,
Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from
http://nccd.cdc.gov/youthonline/.
26 U.S. Census Bureau (2014). B13002 Women 15 to 50 Years Who Had a Birth in the Past 12 Months by Marital Status and Age
[Data]. 2010-2014 American Community Survey 1-Year Estimates. Retrieved from http://factfinder.census.gov/.
27 Inadequate care was defined as a mother receiving less than half of recommended prenatal visits.
28 National Center for Health Statistics (2015). Final natality data [Data]. Retrieved from
http://www.marchofdimes.org/peristats.
24
22
Camden County, an average of 19.7% of all mothers from 2008 to 2010 received inadequate prenatal
care. This figure was 31.3% for mothers under the age of 20, 26.3% for Black mothers, and 25.5% for
Hispanic mothers.
Sexually Transmitted Infections
In Philadelphia, recent data on sexually transmitted infections indicate that they are once again
declining following a period of increase. From 2010 to 2013, cases of syphilis (all stages) were on the
rise; however, they saw a slight decline to 892 cases in 2014. 29 Within 2014 syphilis cases, 48% were
among people known to be HIV-positive. Cases of gonorrhea were on the rise from 2010 to 2012,
peaking at 7,293 cases; however, gonorrhea has also been on the decline, and 2014 saw only 5,961
cases. Incidence of gonorrhea among people with HIV/AIDS was 2.3% in 2014. 30 This trend has also been
seen in chlamydia: cases of chlamydia increased from 2010 to 2012, when they peaked at 20,803, but
have since fallen to 18,935 in 2014. 31 In addition, incidence of chlamydia among people with HIV/AIDS
was also 2.3% in 2014.
In the suburban Pennsylvania counties, cases of chlamydia and gonorrhea rose from 2010 to 2013, and
fell slightly in 2014. 32 The number of cases of primary and secondary syphilis by county are too small to
analyze trends, but at the state level, annual primary and secondary syphilis cases have risen from 369
to 531 from 2010 to 2014.
Trends in sexually transmitted infections vary among the New Jersey counties. For gonorrhea, all
counties but Salem County experienced more cases in 2014 than in 2010. 33 In 2014, there were more
cases of chlamydia in Burlington and Gloucester Counties than in 2010, while there were fewer cases in
Camden County, and slightly fewer cases in Salem County. There were also more cases of primary and
secondary syphilis in the New Jersey counties in 2014 than 2013, although the total for the four counties
was still only 51.
Incarceration
According to a Pew Charitable Trust report as of 2010, Philadelphia had the highest rate of incarceration
of any of the ten major cities in the United States. 34 The prison population in Philadelphia rose from
1999 through 2008, and began to decline in 2009. The Pew report partially attributed this decline to a
Philadelphia Department of Public Health, STD Control (2015). Reported Cases of Syphilis (All Stages) [Data]. Retrieved from
https://hip.phila.gov/Portals/_default/HIP/DataReports/Syphilis/Syphilis_ReportedSyphCaseCountsGenderAge_1990_2014.pdf.
30 Philadelphia Department of Public Health, STD Control (2015). Reported Cases of Gonorrhea [Data]. Retrieved from
https://hip.phila.gov/Portals/_default/HIP/DataReports/Gonorrhea/Gonorrhea_ReportedGCCaseCountsGenderAndAge_1990_
2014.pdf
31 Philadelphia Department of Public Health, STD Control (2015). Reported Cases of Chlamydia [Data]. Retrieved from
https://hip.phila.gov/Portals/_default/HIP/DataReports/Chlamydia/Chlamydia_ReportedCTCaseCountsGenderAndAge_1990_2
014.pdf.pdf
32 Pennsylvania Department of Health, Bureau of Communicable Diseases (2016). Sexually Transmitted Disease [Data].
Retrieved from https://www.phaim.health.pa.gov/EDD/Default.aspx.
33 New Jersey Department of Health, Division of HIV, STD, and TB Services (2016). 2014 Comprehensive STD by County [Data].
Retrieved from http://www.nj.gov/health/std/stdstats/stdstats2014/composite_totals.pdf.
34 The Pew Charitable Trust, Philadelphia Research Initiative. (2016). Philadelphia's Crowded, Costly Jails: The Search for Safe
Solutions (pp. 2-5). Retrieved from
http://www.pewtrusts.org/~/media/assets/2010/05/17/philadelphias_crowded_costly_jails_rev.pdf
29
23
decrease in arrests and partially to a new state policy that moved many inmates from the Philadelphia
Prison System to the state system. In addition, the City of Philadelphia decriminalized the possession of
small amounts of marijuana in October 2014. When comparing year-long arrest data (removing 2014,
since the policy changed partway through the year), this led to an 81.2% decrease in marijuana
possession arrests from 2013 to 2015. 35
Recent data on incarcerated populations is limited, however, and often only available at the state level.
As of 2013, there were 84,538 incarcerated persons in Pennsylvania, with a prison incarceration rate of
391 per 100,000 and a jail incarceration rate of 277 per 100,000. 36 In New Jersey, 40,073 persons were
incarcerated, with a prison incarceration rate of 252 per 100,000 and a jail incarceration rate of 202 per
100,000. There was a daily average of 8,350 inmates in the Philadelphia jail system in 2014. 37 In
addition, a local study found that 3.5% of men within the Philadelphia Prison System were HIV-positive,
and this rate was even higher among women. A PDPH estimate indicated that about 2,739 people living
with HIV were released back into the EMA from county, state, and federal prisons annually. In the first
six months of 2015, 10.1% of medical case management intakes reported incarceration within the
previous twelve months.
Housing
Rent (and rent as a proportion of income) varies across the Philadelphia EMA. In 2014, median income
for Philadelphia renters was $26,624, while median rent was $915 per month. 38 This places median rent
at 41% of median gross household income for renters in Philadelphia, which is higher than the national
figure of 33%. By county within the EMA, this figure ranges from 31% - 40%. However, housing as a
percentage of median income is even more expensive in the cities of Chester and Camden than in
Philadelphia. The median rent in Chester city was $810 in 2014, while median renter household income
was $21,423. The median rent in Camden city was $872, and the median household income for renters
was $18,702. This places median rent to median renter household income at 45% and 56%, respectively.
These figures demonstrate that there are variations in access to affordable housing throughout the
EMA, but housing is particularly unaffordable in cities.
From 2014 to 2015, homelessness increased by 0.6% in Pennsylvania and decreased by 13.5% in New
Jersey. 39 By contrast, homelessness decreased by 2.0% nationally. Unsheltered homelessness increased
in both states, rising 4.2% in New Jersey and a notable 38.4% in Pennsylvania. The national rate
decreased by 1.2%.
Pennsylvania State Police, Pennsylvania Uniform Crime Reporting System (2016). 18F – Drug Possession – Marijuana [Data].
Retrieved from http://ucr.psp.state.pa.us/UCR/Reporting/Query/Summary/QuerySumArrestUI.asp.
36 U.S. Bureau of Justice Statistics (2016). State Imprisonment Rate [Data]. Retrieved from
http://www.sentencingproject.org/the-facts/.
37 Pennsylvania Commission on Crime and Delinquency (2016). Average Daily County Jail Population per 100,000 County
Population 2013 [Data]. Retrieved from
http://pacrimestats.info/trend_reports.aspx?p=\2013\Prisons_and_Jails\County_Jail_Population.
38 U.S. Census Bureau (2015). S2503 Financial Characteristics [Data]. 2010-2014 American Community Survey 5-Year Estimates.
Retrieved from http://factfinder.census.gov/.
39 National Alliance to End Homelessness (2016). The State of Homelessness in America 2016 (pp. 6 – 17). Retrieved from
http://www.endhomelessness.org/page/-/files/2016%20State%20Of%20Homelessness.pdf.
35
24
In Philadelphia, the Office of Homeless Services has a Continuum of Care Board that addresses
homelessness in a number of populations, including people with HIV/AIDS. Their Point in Time Count
(conducted on January 29, 2014) identified 5,738 homeless persons in Philadelphia. 40 Of these, 104 were
people known to be living with HIV/AIDS; 82 of these homeless PLWH were sheltered on the night of the
count.
City of Philadelphia, Office of Supportive Housing (2015). Philadelphia Continuum of Care 2014 Point in Time Summary
[Data]. Retrieved from http://www.phila.gov/osh/PDF/Philadelphia_CoC_2014_Point_inTimeCount.pdf.
40
25
B. HIV Care Continuum
The EMA has used a diagnosed-based HIV Care Continuum for planning and evaluation purposes for
over 5 years. The Philadelphia EMA Ryan White Part A Planning Council (RWPC) and the Philadelphia HIV
Prevention Planning Group (HPG) use these data to make planning decisions.
a. HIV Care Continuum
Philadelphia HIV Care Continuum, 2014
HIV Care Continuum Definitions
HIV-Diagnosed is defined as the number of people living with HIV/AIDS (PLWH) in the EMA who have
been diagnosed with HIV regardless of AIDS status. The data source for this stage is EMA wide HIV/AIDS
surveillance data for PLWH using the person’s current address as of December 31, 2014. The
denominator for this indicator is HIV-diagnosed individuals.
In Care is defined as the number of PLWH in the EMA who had evidence of at least one CD4 count
and/or one viral load and/or received antiretroviral therapy in 2014. The data source for this indicator is
the EMA-wide estimate for Unmet Need, which has been described as the need for HIV primary medical
care among individuals who know their HIV status but are not receiving such care. The denominator for
this indicator is HIV-diagnosed individuals.
Retained in Care is the number of PLWH who received regular medical care in 2014. Regular medical
care is defined as receipt of two or more CD4 counts and/or viral loads during 2014 with at least 90 days
between the results. The data source for this indicator is City of Philadelphia HIV surveillance laboratory
data. The denominator for this indicator is HIV-diagnosed individuals.
26
Prescribed Antiretroviral Therapy is the number of PLWH who have documentation of a prescription for
antiretroviral therapy in their medical records in a calendar year. This data source is local data from the
Medical Monitoring Project (MMP), which tracks the percentage of PLWH in the EMA who are
prescribed ART. MMP is a national probability sample of HIV-infected persons receiving care in the U.S.
in order to describe HIV care and support services being received and the quality of care received. The
most recent local data for the City of Philadelphia for 2013 indicates that 79% of PLWH are on ART. This
represented 97% of PLWH who were in care in the MMP sample. The denominator for this indicator is
HIV-diagnosed individuals.
Virally Suppressed is the number of PLWH whose most recent viral load in 2014 was below 200
copies/mL. The data source is City of Philadelphia HIV surveillance laboratory data. All persons without a
viral load were classified as unsuppressed. The denominator for this indicator is HIV-diagnosed
individuals.
Linkage to Care is the number of PLWH in the EMA who have had a CD4 and/or a viral load test within
three months after their diagnosis. The data source of this stage is City of Philadelphia HIV surveillance
data. The denominator for this indicator is the number of newly diagnosed cases of HIV infection
(regardless of AIDS status) in 2014 within the EMA.
The graph on the previous page illustrates the Philadelphia HIV Care Continuum, which relies on the
number of individuals diagnosed with HIV as its denominator for all points along the continuum. See the
table below to compare the EMA’s continuum to national averages and the National HIV/AIDS Strategy
objectives for 2020 41. Philadelphia’s outcomes along the continuum are better than national estimates.
However, significant improvements are needed to reach the NHAS 2020 objectives. PDPH has efforts
underway and future activities planned to increase the number of PLWH who know their status, who are
engaged in care, and who are virally suppressed. PDPH analysis suggests that improving linkage to care
could have the greatest impact on reducing the number of PLWH who are not engaged in HIV care
(Unmet Need) in the future. Of the persons with Unmet Need in 2013, 42.2% had never linked to care
after their initial HIV diagnosis; 36.7% had been linked to care in the past but had been lost to care for
the 2 years prior to 2013; and 21.1% had evidence of care in either 2011 or 2012, indicating they were
receiving sporadic care.
Engagement in Care Comparison
Diagnosed
Linkage to Care
Retained in Care
Virally Suppressed
41
EMA Continuum 2014
National Estimates 2012 42
NHAS Goals by 2020
90%
82%
52%
54%
86%
80%
54%
42%
90%
85%
90%
80%
For more information on the National HIV/AIDS Strategy Updated for 2020 see the fact sheet at:
https://www.whitehouse.gov/the-press-office/2015/07/30/fact-sheet-national-hivaids-strategy-updated-2020
42
The data for the national estimates are all 2012 data, except for the Linkage to Care which is for people
diagnosed in 2013 who were linked to care within a month of diagnosis.
http://www.cdc.gov/hiv/pdf/Continuum_Surveillance.pdf
27
Further discussion of the Continuum includes disparities by subpopulations, as well as, PDPH activities to
improve outcomes along the Continuum. More information on programmatic objectives, strategies, and
activities can be found in Section II A.
b. Disparities Along the Continuum
HIV Diagnosis
Significant disparities exist in HIV (not AIDS) incidence in the EMA for men, racial minorities, youth and
young adults, and MSM. Minority populations make up the majority of the cases (80.4%) more recently
infected with HIV in the EMA and 87.0% of the cases in the City of Philadelphia. Among persons recently
diagnosed with HIV (not AIDS), a greater proportion of cases among women, youth ages 13-24, MSM,
and heterosexuals occur among minorities.
Men account for more than three-fourths of HIV cases. HIV cases among women in the EMA are stable.
Less than one-quarter of newly diagnosed HIV cases occurred among women from 2012 to 2014.
A growing number of newly diagnosed HIV (not AIDS) cases are among youth. Most of the cases of
newly diagnosed HIV (not AIDS) are among persons age 20 – 39. However, a growing number of HIV
cases are occurring in the 13 – 24-year-old age group (26.7%).
The low HIV incidence among people who inject drugs (PWID) is likely the result of the availability of
syringe exchange in the City of Philadelphia. Less than 7% of new HIV infections occurred in PWID from
2012 to 2014.
HIV diagnoses have been relatively stable between 2012 and 2014. Sub-populations most affected are:
Latinos (7.9% increase), those 50 and over (27.4% increase), and MSM (14.2% increase). Meanwhile,
significant declines occurred among females (21.6% decrease), Whites (8.7% decrease), Blacks (7.5%
decrease), PWID (31.1% decrease) and heterosexuals (8.2% decrease). Diagnoses were stable in all other
groups.
Concurrent Diagnosis of HIV/AIDS
Trend data on concurrent HIV/AIDS diagnosis (persons diagnosed with AIDS within 3 months of their HIV
diagnosis) indicates that both the number and proportion of persons with concurrent HIV/AIDS have
decreased over the last several years: 30.1% in 2011, 29.7% in 2012, 26.6% in 2013, and 24.8% in 2014.
The decline in concurrent HIV/AIDS is likely driven by increases in routine opt-out HIV testing,
specifically in Philadelphia. Women, Whites, and those infected through heterosexual transmission are
more likely to be diagnosed with concurrent HIV/AIDS. The risk of concurrent HIV/AIDS significantly
increases in persons over the age of 30, and worsens even more among persons over the age of 40.
Significant geographic differences occur in the diagnosis of concurrent HIV/AIDS, PLWH in the
Pennsylvania counties are more likely than those in Philadelphia or the New Jersey counties to be
concurrently diagnosed.
28
Sub-Populations of PLWH by Percent, Philadelphia EMA, 2014 43
2.9
EMA
Philadelphia
NJ counties
PA counties
2.2
2.1
1.4
0.2
0.4
0.8
0.6
0.5
0.5
0.1
0.2
White Males
1.1
0.9
1.1
Hispanic Males
0.3
0.5
0.8
0.9
1.0
Black Males
Black Females Hispanic Females
Living with HIV/AIDS
HIV/AIDS prevalence rates are notably higher in Philadelphia compared to the four Pennsylvania and
four New Jersey counties for the same period. Rates are greatest among Black men, followed by
Hispanic men, Black women, Hispanic women, White men, and White women. About 0.5% of all
residents of the EMA are living with HIV/AIDS and aware of their status. However, the prevalence in the
City of Philadelphia, which represents more than three-fourths of the EMA’s epidemic, is 1.3% and as
high as 2.9% in Black males, which meets the definition of a generalized epidemic. In the surrounding
Pennsylvania and New Jersey counties, HIV is confined mainly to individuals who engage in high-risk
behaviors, such as MSM, PWID, or sex workers.
In Care
Unmet Need for HIV primary care remains stable in the EMA at 19%. 44 After several years of consistent
declines, the level of Unmet Need has plateaued for PLWH, PLWA, and the combined population. The
estimate demonstrates that the declines are the result of systematic, concentrated efforts to identify,
inform, refer, link, and retain in care PLWH through implementation of the EMA’s EIIHA strategy;
increased focus on retention in care through monitoring and quality management of RW provider
services for PLWH; and innovative uses of surveillance and client outcome data to track progress on
identifying, informing, referring, linking and retaining in care persons who test positive for HIV.
43
White women are purposefully excluded from this graph because the percentage of White women in the EMA
living with HIV/AIDS is so low. To include the percentage would make the graph less readable/useful to the reader.
44
Unmet Need has been described as the need for HIV primary medical care among individuals who know their
HIV status but are not receiving such care. This is different than measuring “retention in care”, which is measured
here as receipt of two or more CD4 counts and/or viral loads during 2014 with at least 90 days between the
results.
29
Estimates for Engagement in Care for MSM of Color
% Estimate Number
HIV-infected
HIV-diagnosed (as of December 31, 2014)
Linked to HIV care
Retained in HIV care
On ART
Suppressed viral load (<=200 copies/mL)
100%
87%
70%
45%
55%
48%
7,033
6,105
4,915
3,144
3,839
3,364
Source: PDPH, 2015
Retained in Care
City of Philadelphia HIV surveillance data was used to examine disparities in Retention in Care. Males
have lower rates of retention (48.8%) compared to females (57.0%) and transgender individuals (62%).
Whites have lower rates of retention (46.1%) compared to Blacks (52.7%) and Latinos (51.8%) regardless
of transmission risk. MSM (49.6%) and PWID (48.3%) have lower rates of retention compared to PLWH
infected through heterosexual transmission (55.2%). PLWH >65 years of age have lower rates of
retention (45.8%) compared to all other age groups (51.9%).
It is important to look at the Continuum as a whole, especially when looking at retention in care. An
individual with a history of viral suppression may only go to the doctor once a year, and therefore not
meet measurements for “retention in care”. Local data from Philadelphia indicates that 19.2% of PLWH
who were virally suppressed in 2014 did not meet the retention in care measure. A study by Yehia et. al.
(2015) found that 10.0% of patients in a cohort of 17,140 patients from 11 U.S. HIV clinics were not
retained in HIV care but had a suppressed viral load. 45 Additionally, based on this study, a greater
proportion of patients would be classified as having met need, given they were retained in HIV care,
despite the fact that they did not achieve viral suppression.
On ART
Youth aged 18 – 24 are less likely to be prescribed ART (81.7%) compared to persons 25 – 49 years of
age (98.9%) and persons over 50 years of age (100%). No other disparities by sex, race/ethnicity, or
mode of transmission have been identified.
Viral Suppression
The Philadelphia HIV surveillance data was used to examine disparities in viral suppression. There were
no significant disparities in viral suppression based sex at birth and race/ethnicity. PWID and MSM/IDU
have lower rates of viral suppression (48.3% and 47.9%, respectively) compared to MSM (54.7%) and
persons infected through heterosexual contact (56.3%). Persons <35 years of age are less likely to be
virally suppressed (49.1%) compared to persons >35 years of age (54.6%). Transgender individuals have
Yehia, B.R. et al. (April 2015). Impact of age on retention in care and viral suppression. Journal of Acquired Immunodeficiency.
68(4), 413-419.
45
30
higher rates of viral suppression than the overall PLWH population (62%). There were no disparities
found by race/ethnicity or within individual risk groups of MSM, PWID, or heterosexual transmission.
c. Continuum Use in Planning
In planning for 2016, the RWPC carefully analyzed the relationship between the local Continuum and
eligible Ryan White service categories. PDPH staff, PLWH, community members, providers of Ryan White
and other services, and OHP staff collaborated to develop a description of the extent to which each
service category improved an individual’s engagement in each stage of the Continuum. This RW service
Continuum was a weighted factor of 30% in RWPC’s priority setting tool. The factor quantified the
impact of service categories along the Continuum, so that the more stages that a single service
supported, the higher its final score. This iteration of the Continuum is used to better inform where and
how to implement specific Ryan White services and MAI funding to address identified disparities. PDPH
provides RWPC with performance outcomes along the Continuum for services to ensure the Part A
program effectively addresses gaps in engagement.
Planning Council Determined Ryan White Services Along the Continuum
100%
Outpatient/Ambulatory Health Care
Health Education Risk Reduction
90%
Linquistic Services
Outreach Services
Referral for Health Care Services
80%
Early Intervention Services
Health Insurance Premium and Cost Sharing Assistance for Low-Income
Medical Case Management
Mental Health
Substance Abuse Outpatient Care
Child Care Services
Medical Transportation
Non-Medical Case Management
Pyschosocial Support
Substance Abuse Services (residential)
Home and Community-Based Health Services
Home Health Care
Medical Nutritional Therapy
Oral Health Care
Emergency Financial Assistance
Food Bank/Home Delivered Meals
Housing
Other Professional Services/Legal
70%
60%
50%
40%
30%
20%
10%
Rehabilitation
LPAP
ADAP
0%
HIV Diagnosed 100%
31
Linked to Care 81%
Retained in Care 52%
On ART 76%
Virally Suppressed
54%
C. Financial and Human Resources Inventory
This section contains an inventory of the identifiable financial and service delivery resources available in
the Philadelphia EMA. CDC-funded high impact prevention services, HRSA-funded core medical and
support services, city funded services, and services available through other funded sources both private
and public have been provided in table format. A table has been included that describes funding sources
and services for Section I: C.a.i, ii and iv as outlined in the guidance. Another table can be found in
Appendix A which includes funded service providers both public and private addressing guidance Section
I: C.a.iii.
Section I: C. b is addressed in a table (found in Appendix A) that provides an overview of the HIV
workforce capacity in the jurisdiction based on the overall occupational outlook as defined by the United
States Department of Labor, Bureau of Labor Statistics for the eight county area of Bucks, Chester,
Delaware, Montgomery, Philadelphia, Burlington, Camden, and Gloucester. Data for Salem County, New
Jersey was not available, because it was included in a separate Metropolitan Statistical Area (MSA).
Designated Health Professional Shortage Area Statistics as reported by the Bureau of Health Workforce,
Health Resources and Services Administration are also included. Both New Jersey and Pennsylvania are
designated health professional shortage areas.
32
2016
2015
a. Funding Sources and Services, Actual for 2015 and Anticipated for 2016
Funding Source
Dollar Amount
%
Dollar Amount
%
Core Services
Outpatient/Ambulatory
Medical Care
AIDS Drug Assistance
Program
AIDS Pharmaceutical
Assist.
Oral Health Care
Part A
23,515,526
Part D
2,333,743
Part F
278,693
CDC
7,527,547
SAMHSA
1,657,117
1.0%
14.3%
16.7
3.2%
1.4%
0.2%
4.6%
27,385,953
5,148,591
2,257,406
261,620
8,943,170
15.1%
16.3%
3.1%
1.3%
0.2%
5.3%















Home & Communitybased Health Services
Hospice Services
Medical Nutrition
Therapy
Medical Case
Management
Substance Abuse Services
– Outpatient
Part C
5,243,110
25,428,282
Early Intervention
Services
Health Insurance
Premium/ Cost-Sharing
Assistance
Home Health Care
Mental Health Services
Part B
27,385,953





















Non-medical Case
Management
Child Care Services
Emergency Financial
Assistance
Food Bank/Homedelivered Meals
Health Education/Risk
Reduction
Housing Services
Supportive Services
Legal Services


Linguistic Services
Medical Transportation
Services
Outreach Services
Psychosocial Support
Services
Referral for Health Care/
Supportive Services
Rehabilitation Services
Respite Care
Substance Abuse Services
– Residential
Treatment Adherence
Counseling
Psychosocial Support
Services
HIV Testing
33














2016
2015
Funding Sources and Services, Actual for 2015 and Anticipated for 2016 Continued
Funding Source
HOPWA
Other HUD
State
Local
3rd Party
Reimbursements
and Rebates
Total All Funding
Dollar Amount
7,951,436
2,435,519
7,160,256
1,988,161
76,814,351
164,291,412
4.8%
1.5%
4.4%
1.2%
46.8%
100%
9,104,000
2,435,519
7,160,256
1,988,161
77,815,563
167,928,521
5.4%
1.5%
4.3%
1.2%
46.3%
100%



%
Dollar Amount
%
Core Services
Outpatient/Ambulatory
Medical Care
AIDS Drug Assistance
Program
AIDS Pharmaceutical
Assist.
Oral Health Care



Early Intervention
Services
Health Insurance
Premium/ Cost-Sharing
Assistance
Home Health Care


Home & Communitybased Health Services
Hospice Services



Mental Health Services
Medical Nutrition
Therapy
Medical Case
Management
Substance Abuse Services
– Outpatient



Non-medical Case
Management
Child Care Services
Emergency Financial
Assistance
Food Bank/Homedelivered Meals
Health Education/Risk
Reduction
Housing Services






Supportive Services
Legal Services

Linguistic Services
Medical Transportation
Services
Outreach Services

Psychosocial Support
Services
Referral for Health Care/
Supportive Services
Rehabilitation Services
Respite Care
Substance Abuse Services
– Residential
Treatment Adherence
Counseling
Psychosocial Support
Services
HIV Testing



34
HIV Care Continuum Steps/Services Impacted
Stages of the HIV Care
Continuum
I. Diagnosed
Goal
Increase the percentage of clients
who are aware of their status
Increase the percentage of clients
linked to care
II. Linked to Care
III. Retained in Care
IV. Prescribed ART
V. Virally Suppressed
35
Increase the percentage of clients
retained in medical care
Increase the percentage of clients
with access to prescribed HIV/AIDS
medications consistent with HHS
Treatment Guidelines
Increase the percentage of clients
with a viral load of <200 copies/mL
Service Category (One or
more may apply)
O/A Medical Care, Referral
for Healthcare/ Support
Services
O/A Medical Care, Medical
Case Management
Substance AbuseOutpatient, Housing
Services, Medical
Transportation
O/A Medical Care, Medical
Case Management, Oral
Health Care, Mental Health
Services, Substance AbuseOutpatient, Medical
Nutrition Therapy, Housing
Services, Medical
Transportation, Referral for
HC/Support Services, Food
Bank/HD Meals, Emergency
Financial Assistance, Legal
Services
b. Work Force Capacity
The work force capacity table found in Appendix A is an overview of the area’s workforce. Federal data
was used to estimate the HIV workforce because specific data regarding the local HIV service workforce
are not available. 46 Many public and private health systems serve the region’s PLWH and those
individuals most at risk.
According to federal labor statistics, key workforce shortages for the EMA include:
•
•
•
•
•
•
•
•
•
•
•
•
•
Community health workers
Counselors
Dentists (specialists)
Dieticians
Epidemiologists
Health educators
Healthcare support workers
Internists (general)
Obstetricians and gynecologists
Pediatricians
Psychiatric aides and technicians
Social scientists
Social workers
To further illustrate workforce capacity issues, data from the Bureau of Clinician Recruitment and
Service, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human
Services is provided on the next page. This analysis looks at the shortages of medical professionals in
various geographic areas. Health Professional Shortage Area (HPSA) designations have been used to
identify areas and population groups within the United States that are experiencing a shortage of health
professionals. “There are three categories of HPSA designation based on the health discipline that is
experiencing a shortage: 1) primary medical; 2) dental; and 3) mental health. The primary factor used to
determine a HPSA designation is the number of health professionals relative to the population with
consideration of high need. Federal regulations stipulate that, in order to be considered as having a
shortage of providers, an area must have a population-to-provider ratio of a certain threshold. For
primary medical care, the population to provider ratio must be at least 3,500 to 1 (3,000 to 1 if there are
unusually high needs in the community).”47
46
The data is from the United States Department of Labor, Bureau of Labor Statistics, Occupation Outlook Handbook, May
2014. The areas contained in this table represent Metropolitan Divisions 15804 (Burlington, Camden, and Gloucester counties)
and 37964 (Bucks, Chester, Delaware, Montgomery, and Philadelphia counties). Retrieved from
http://www.bls.gov/oes/current/oes_37964.htm
47 Bureau of Clinician Recruitment and Service, Health Resources and Services Administration (HRSA), U.S. Department of
Health & Human Services, HRSA Data Warehouse: Designated Health Professional Shortage Areas Statistics, as of December 31,
2015. Retrieved from:
file:///W:/2016%20Integrated%20Prevention%20&%20Care%20guidance/articles%20and%20other%20materials/Designated%
20HPSA%20Statistics.pdf
36
The Health Professional Shortage Area for Pennsylvania and New Jersey, as of December 31, 2015
Location
Total Primary Care HPSA
Designations 48
New Jersey
Pennsylvania
30
159
54.90%
63.70%
Percent of Need Met
35
164
25.96%
38.98%
Percent of Need Met
33
122
71.51%
60.84%
Dental Care
New Jersey
Pennsylvania
Mental Health Care
New Jersey
Pennsylvania
Percent of Need Met 49
Practitioners Needed to Remove HPSA
Designation 50
13
88
Practitioners Needed to Remove HPSA
Designation
23
310
Practitioners Needed to Remove HPSA
Designation
4
44
The city of Philadelphia has an adequate number of primary care providers, but these providers are not
evenly distributed throughout the city. A study commissioned by PDPH found six neighborhoods had
high population to provider ratios. 51 As measured by adults per primary care provider, the highest
access neighborhoods have ten times more access than the lowest access neighborhoods. The
population-to-provider ratios ranged from 250:1 to over 2600:1. Most of the lowest access
The number of additional primary care physicians, dental care and mental health care providers needed to achieve a
population-to-primary care physician ratio below the thresholds necessary for designation in all designated primary care HPSAs
that would result in their removal from designation. The formula used to designate primary care HPSAs does not take into
account the availability of additional primary care services provided by nurse practitioners and physician assistants in an area.
The figure reported for Practitioners Needed to Remove Designations for facility HPSAs includes correctional facilities. It
excludes facilities not located in a HPSA that are designated based on providing services to the population of a geographic or
population HPSA. It also excludes facilities automatically designated based on statute, including health center program
grantees, Federally Qualified Health Center Look Alikes, Indian Health Service facilities, and rural health clinics that meet NHSC
site requirements.
49 The Percent of Need Met is computed by dividing the number of primary care physicians, dental care and mental health care
providers available to serve the population of the area, group, or facility by the number of dentists that would be necessary to
reduce the population to provider ratio below the threshold for designation so that it would eliminate the designation as a
dental HPSA. Federal regulations stipulate that, in order to be considered as having a shortage of providers, a designation must
have a population-to-provider ratio that meets or exceeds a certain threshold. For dental geographic designations, the ratio
must be at least 5,000 to 1. For dental population designations or geographic designations in areas with unusually high needs,
the threshold is 4,000 to 1. For correctional facilities, the threshold is 1,500:1 and takes into account the average length of stay,
and whether or not intake examinations are routinely performed.
50 The Percent of Need Met is computed by dividing the number of primary care physicians, dental care and mental health care
providers available to serve the population of the area, group, or facility by the number of providers that would be necessary to
reduce the population to provider ratio below the threshold for designation so that it would eliminate the designation as a
dental HPSA. Federal regulations stipulate that, in order to be considered as having a shortage of providers, a designation must
have a population-to-provider ratio that meets or exceeds a certain threshold. For dental geographic designations, the ratio
must be at least 5,000 to 1. For dental population designations or geographic designations in areas with unusually high needs,
the threshold is 4,000 to 1. For correctional facilities, the threshold is 1,500:1 and takes into account the average length of stay,
and whether or not intake examinations are routinely performed.
48
Brown, E., Grande, D.T., Barber, C.M., Polsky, D.E., Seymour, J.W. (May 2015). Location Matters: Differences in Primary Care
Supply by Neighborhood in Philadelphia. Retrieved from http://ldi.upenn.edu/sites/default/files/location-matters-fullreport060715.original.pdf
51
37
neighborhoods were also ones with concentrated poverty and a high percentage of minority
populations. These same factors are associated with neighborhoods with increased HIV risk 52.
c. Coordination of HIV Prevention, Care and Treatment Services and Funding Sources
All Ryan White Part A funding is coordinated through PDPH’s AIDS Activities Coordinating Office (AACO).
Philadelphia EMA Ryan White Part A Planning Council (RWPC) plans activities in coordination with all
other known public funding for HIV/AIDS and, to the extent possible, private grant programs that are
implemented in partnership with Ryan White settings. Coordination of all these resources ensures that
Ryan White funds are the payer of last resort, maximizes the number and accessibility of services
available, and reduces duplication. Part A funding is somewhat more flexible than other public sources
and is strategically allocated to necessary services and activities. This is due in large part to limitations
on other resources which results in the inability to fully meet the need, e.g. funding restrictions or
geographic constraints, or for which there is no other payer.
The EMA maintains a comprehensive HIV testing program that leverages city, state, federal, and private
resources in a coordinated system that integrates routine testing in healthcare settings and supports
targeted testing in community-based settings. As the recipient for CDC HIV funding in Philadelphia,
PDPH is able to implement full coordination among HIV surveillance, prevention, and care services as
well as engage a broad range of partners in the Continuum, including the New Jersey and Pennsylvania
Departments of Health, the Philadelphia Prison System, emergency shelters, and other PDPH divisions,
including Ambulatory Health Services, Division of Disease Control, STD Control. PDPH coordinates efforts
with a large number of private sector entities, including community health care providers,
hospitals/emergency departments, Federally Qualified Health Centers, maternal home visiting
programs, HIV/AIDS services organizations, and several HIV service demonstrations projects.
d. Efforts to Identify and Secure Needed Services
Housing
EMA resources are unable to meet current housing needs of PLWH. The waiting list for HOPWA housing
was approximately 350 people in January 2016. As of this plan, there were about sixty people on that
waiting list for the HOPWA program in the New Jersey counties. Philadelphia’s Division of Housing and
Community Development estimates that it would need approximately $3.85 - 4 million in additional
funding per year, as well as increased capacity, to end its HOPWA waiting list. The waiting list for the
Housing Choice Voucher Program (formerly known as Section 8) has not been open in Philadelphia since
2010, and the waiting list will not reopen until the majority of those applications are served. 53 The
current wait list has 100,000 people. The wait is estimated to be ten years. 54
The findings of a geographic analysis of social determinants of HIV risk was completed in 2011 by OHP. The results of this
analysis found that neighborhoods with the highest rates of PLWH were also neighborhoods with low socio-economic status,
high concentrations of Black residents, high death rates, high birth risk, low neighborhood stability, and high crime rates of
multiple types. The full analysis can be downloaded: http://hivphilly.org/Documents/2011GeoReport.pdf
53 Philadelphia Housing Authority (2015). Housing Choice Voucher Waiting List Update. Retrieved from
http://www.pha.phila.gov/pha-news/pha-news/2015/hcv-waiting-list-application-update.aspx.
54 Long wait, high demand for PHA housing. Philadelphia Tribune. May 16, 2016. Retrieved from:
http://www.phillytrib.com/metros/long-wait-high-demand-for-pha-housing/article_d7cde3e7-afde-5026-ba57aab2b80304f4.html
52
38
In an effort to mitigate some of the unmet housing need of PLWH, the RWPC is assessing the feasibility
of using Ryan White Part A funds to provide for short term transitional housing. Priority would be given
to individuals experiencing homelessness. The RWPC will also explore the feasibility and impact of a
Housing First program. The RWPC allocated Part A funds to rental vouchers (for Philadelphia only) in the
2017-2018 fiscal year, should the EMA receive a significant increase in Part A funds.
Health Insurance Cost-Sharing
The RWPC has identified health insurance cost-sharing as a possible barrier for privately insured PLWH.
Pennsylvania is one of a few states not to cover health insurance premiums and cost-sharing assistance
for Ryan White-eligible PLWH. At this time, Pennsylvania’s ADAP program does not provide cost-sharing
assistance for HIV-related healthcare and laboratory tests, only for prescription drugs. The RWPC
allocated Part A resources for fiscal year 2017-2018 to fund a pilot program to provide cost-sharing
assistance for privately insured PLWH in Philadelphia. At the time of this plan, the RWPC was working
with PDPH to develop the reimbursement/payment mechanisms and eligibility requirements for the
program. As of July 1, 2016, New Jersey funded organizations in the EMA to support co-pays and costsharing dependent on a detailed policy indicating a knowledge of insurance plans and a detailed tracking
system to monitor true out of pocket costs (TROOP). The New Jersey Department of HIV, STD, and
Tuberculosis Services (DHSTS) supports only Silver marketplace plans with a 70% actuarial value.
39
D. Assessing Needs, Gaps, and Barriers
The following needs assessment demonstrates that rising HIV prevalence significantly increases demand
on available resources and highlights disproportionate impact on vulnerable populations. Multiple
primary and secondary data sources were used to assess jurisdictional needs, including quantitative and
qualitative research conducted by Office of HIV Planning (OHP) and PDPH. These data provide
compelling evidence that, despite the availability of high quality outpatient ambulatory medical care and
other medical and psycho-social services, health disparities persist for PLWH and other vulnerable
communities. Although HIV incidence is stable or decreasing for most populations, the MSM and youth
populations experience disproportionate risk of acquiring HIV. The HIV prevention system, which
includes routine and targeted testing, PrEP, nPEP, condom distribution, partner services, and linkage
navigation services, is targeted to address the disparities experienced by these populations.
This discussion will summarize the service needs and barriers in both the HIV prevention and care
system in the EMA. The processes and data used to identify service needs, gaps, and barriers will be
followed by a description of those identified needs, gaps and barriers.
a. Needs Assessment Process
Community input into the planning process is assured through multiple means. Memberships of the Part
A Ryan White Planning Council (RWPC), the Philadelphia HIV Prevention Planning Group (HPG), and their
respective committees reflect the demographics of the local HIV/AIDS epidemic. Community
participation is welcomed by both the RWPC and HPG; all meetings are open to the public. Members
and guests receive transportation reimbursement and refreshments at meetings. Language
interpretation services are provided whenever requested within reasonable timeframes. Members and
participants regularly receive training and data necessary to make planning decisions from OHP and
PDPH staff and other local experts. Annually, both planning bodies actively recruit members to meet any
gaps in representation. The Positive Committee represents the needs of PLWH through formal planning
processes and needs assessment activities.
The Office of HIV Planning (OHP) supports the planning bodies in their assessment of service needs, gaps
and barriers by providing data collected from other sources, as well as conducting original research on
current needs in care and prevention services. Major needs assessment activities conducted by OHP
since 2012 include the 2012 Ryan White consumer survey, focus groups with young MSM and
heterosexuals of low socio-economic status, an online survey of medical case managers about consumer
need for local pharmaceutical assistance, and surveys of both PLWH and providers about transportation
access for PLWH. Information collected in these activities informs all planning processes, including
development of this integrated plan, and service priorities and regional allocations of Ryan White
funding.
OHP Needs Assessment Activities
Ryan White consumers were surveyed on their access to services, gaps, and barriers to care in the 2012
consumer survey. This survey was also conducted in 2007 and 2002. OHP worked with the EMA’s Ryan
White providers to ensure that a random sample of 25% of their clients received the survey through the
40
U.S. mail. Survey questions included basic demographics, health outcomes, barriers to services, and
consumer priority for services. OHP received and analyzed 700 responses from the 3,500 survey
distributed. The majority of the respondents were long-term survivors who were retained in care and
had a suppressed viral load. These data tend to reflect the needs of consumers who are accessing
services. Consumer survey data give the EMA information on service needs at the retained in care, on
ART, and virally suppressed stages in the Continuum. Results from the survey informed RWPC and HPG
efforts along the Care Continuum and also informed the Ryan White Part A service priorities and
regional allocations. The survey asks consumers if there were services they needed but did not receive
and why they didn’t receive those services. These responses help RWPC and PDPH mitigate service gaps
and barriers. Another consumer survey is scheduled for 2016/2017. OHP will work to update the survey
to reflect the NHAS goals and indicators, as well as to collect data to evaluate the impact of ACA on the
EMA’s PLWH.
As a part of stakeholder engagement, OHP conducted focus groups in 2014 with MSM aged 18-30 and
heterosexuals of low socio-economic status aged 25-65. 55,56 The discussions focused on the participants’
experiences with primary and HIV specialty healthcare and HIV testing. Future focus groups with other
populations are planned for 2017/2018. OHP shared the analysis with the HPG, RWPC, HIV service
providers, federal partners, and community members through formal and informal means.
OHP has used geography to analyze social determinants of health for over a decade. In 2011, OHP
requested Public Health Management Corporation conduct a multinomial logistic regression analysis of
the relationships between HIV risk and 15 indicators of severe need in Philadelphia census tracts. 57 In
2015, OHP completed maps of over 60 social determinants for each of the EMA’s counties. 58 These maps
are used by RWPC and HPG to explore how social determinants like income, education, race/ethnicity,
racial segregation, and disease and crime prevalence affect HIV risk and access to HIV care.
In fall 2015, PDPH requested that OHP conduct an online survey of medical case managers to better
understand why and how the Local Pharmaceutical Assistance Program (LPAP) was used in the EMA.
Case managers were asked about the situations in which clients rely on the program and barriers to
accessing medications through other payers. These data informed the RW Part A grant application and
the RW regional allocations for the service in FY2016/2017.
OHP conducted another online survey of RW medical case managers about PLWH access to
transportation in 2016. The short survey asked how the provider organizations assisted clients attending
medical appointments and what barriers providers and consumers experienced in accessing RW and
Medicaid medical transportation. A similar survey was conducted with the members of the Positive
The focus group analysis, Experiences with HIV testing and Health Care in Philadelphia: Young men who have sex with men, is
available for download: http://www.hivphilly.org/Reports/YMSM.pdf
56 The focus group analysis, Experiences with HIV testing and Health Care in Philadelphia: High Risk Heterosexuals, is available
for download: http://hivphilly.org/Reports/HRH.pdf
57 The 2011 Geographic Risk Analysis is available at http://www.hivphilly.org/Documents/2011GeoReport.pdf
58 Data availability varies by county so not every county has data on every factor. The 2015 social determinant maps for each of
the EMA’s counties are available for download: http://www.hivphilly.org/documents.html
55
41
Committee in 2015. Those results informed the survey for case managers and discussions within the
Needs Assessment, Positive, and Comprehensive Planning Committees of the RWPC.
PDPH and National Data Sources
Client Services Unit data measure client needs at PDPH Ryan White medical case management intake.
Presenting needs will be high and generally unmet, because most of the clients calling are not currently
retained in HIV care, even if they were so previously. These data give the EMA information on service
needs at the HIV diagnosed and linked to care stages in the Continuum. These data are used to
determine RW service priorities and regional allocations.
Medical Monitoring Project is a nationally representative, population-based surveillance system to
assess clinical outcomes, behaviors, and the quality of HIV care. Data on 191 persons interviewed for
MMP from Philadelphia for 2013 produced information about met and unmet needs for HIV care and
care-related services. These data give the EMA information on service needs at the linked to care,
retained in care, and on ART stages in the Continuum. These data are used to determine RW service
priorities and regional allocations and inform RWPC about the service needs for PLWH who may not be
RW clients.
National HIV Behavioral Surveillance (NHBS) is conducted in rotating, annual cycles, in three different
populations at increased risk for HIV: men who have sex with men (MSM), people who inject drugs
(PWID), and heterosexuals at increased risk for HIV infection. NHBS collects data in 22 project areas with
high prevalence of HIV, of which Philadelphia is one. These data inform RWPC and HPG on risk
behaviors, testing patterns, general demographics, HIV prevalence, and substance use of local at-risk
populations.
b. Identified Service Needs of PLWH and Those at Most Risk
Poverty is a significant factor driving the needs of people at risk for and living with HIV (PLWH) in the
EMA. Poverty reduces access to healthcare. Living in poverty limits individuals’ abilities to make healthy
choices and adhere to treatment. Even “nominal costs” or co-payments of a few dollars can prevent a
person living in poverty from accessing care and medications. Most of the EMA’s Ryan White clients are
living in or near poverty and are insured by public insurance (like Medicare or Medicaid) or are
uninsured. The EMA’s coordinated and comprehensive HIV service continuum cannot meet all the needs
of all PLWH and those at-risk. Service gaps exist because of lack of adequate funding, limited human
resources, competing political priorities, and other factors. PDPH, OHP, and the community planning
bodies (RWPC and HPG) work together to identify and address all service needs, gaps, and barriers with
the resources available.
PDPH and RWPC regularly assess changes to needs and service gaps due to the implementation of the
ACA. The expansion of Medicaid eligibility within the EMA was sporadic and inconsistent due to political
changes in Pennsylvania. As of 2015, both Pennsylvania and New Jersey have expanded eligibility to all
adults under 138% FPL. Considering the prevalence of poverty within the local population and
particularly in PLWH, the EMA expects to see a decrease in the number of uninsured PLWH over the
next five years. PDPH, HPG, and RWPC will work to ensure that all the resources available target the
current and emerging needs in the era of ACA, and that RW funds remain the payer of last resort.
42
High Quality HIV and Primary Care
The EMA ensures access to high quality HIV medical care for all eligible PLWH through a coordinated
system of diverse RW-funded providers. Despite the availability of high quality outpatient ambulatory
medical care and other core and support services, many PLWH face disproportionate risks and effects of
social determinants, particularly racial/ethnic minorities, men, and persons 20-49 years of age. In 2014,
an estimated 27,121 people were living with HIV/AIDS in the Philadelphia EMA; 11,843 people were
living with HIV not AIDS and another 15,278 people were living with AIDS. Over the past three years,
2,120 new cases of HIV and 1,172 new AIDS cases were reported. In 2014, over 14,000 unduplicated
clients with HIV/AIDS received outpatient ambulatory medical care through the Ryan White Program,
representing over half of the total number of people living with HIV/AIDS in the EMA.
Unmet Need for HIV primary care remains stable in the EMA. After several years of consistent declines,
the level of Unmet Need has plateaued for PLWH, PLWA, and the combined population. According to
the Unmet Need estimate for 2016 (current methodology), there were 5,197 PLWH (19%) who had not
received the specified HIV primary care (2 viral loads in 12 months). PDPH determined that the declines
are the result of systematic, concentrated efforts to identify, inform, refer, link, and retain in care
persons who test positive for HIV through implementation of the EMA’s EIIHA strategy; increased focus
on retention in care through monitoring and quality management of RW services for PLWH; and
innovative uses of surveillance and client outcome data to track progress on identifying, informing,
referring, linking and retaining in care persons who test positive for HIV. Unmet need is more prevalent
in some subpopulations like Blacks, Hispanics, and those between 20-29 and 30-39, compared to other
racial/ethnic groups and age groups. See Section I. B. for more discussion on engagement in HIV care
along the Care Continuum.
According to county health rankings compiled by the Robert Wood Johnson foundation, the EMA
contains the most and least healthy counties in Pennsylvania – Chester (1) and Philadelphia (67). The
three remaining counties’ rankings demonstrate the differences between social and economic
conditions among neighboring counties: Montgomery (3), Bucks (6), and Delaware (35). Out of the 21
counties in New Jersey, the EMA’s four counties’ rankings ranged: Burlington (9), Gloucester (16), Salem
(16) and Camden (19). 59 The EMA’s three counties with the lowest rankings are also the three counties
with the largest HIV epidemics and greatest numbers of new HIV cases. 60
In the EMA, the communities most affected by HIV are often also the poorest. Poverty creates barriers
to care and gaps in services for many of the EMA’s PLWH and those at-risk. While the Affordable Care
Act (ACA) expanded access to health insurance and primary care for many people, health insurance is
not healthcare. Many previously uninsured people do not have experience navigating service systems
and may not understand their benefits or the services available to them. These newly-insured
individuals need assistance from navigators and medical case managers to fully benefit from expanded
access to clinical services.
59
Robert Wood Johnson Foundation. County Health Rankings. Retrieved May 2016 from http://www.countyhealthrankings.org
Office of HIV Planning. (2015). Integrated Epidemiological Profile for HIV/AIDS Prevention and Care Planning, Philadelphia
Eligible Metropolitan Area. Retrieved from http://www.hivphilly.org/EpiProfile/2015Epi.pdf
60
43
Medical Case Management
Medical case management services help PLWH access supportive and medical services that enable them
to stay in care and adhere to treatment. Local data confirm that persons who receive MCM are 1.7 times
more likely to be retained in care each year than persons who did not receive MCM. The EMA makes
every effort to ensure system capacity to provide medical case management services to all eligible
PLWH. RWPC prioritizes medical case management (MCM) as service priority #1; understanding that the
MCM system is the fundamental mechanism in the EMA that assists clients in removing barriers to
accessing and retaining outpatient/ambulatory medical care and other core and supportive services. In
2014, the RW system provided medical case management to 6,363 clients.
In the EMA, PLWH access RW medical case management through the central intake at PDPH Client
Services Unit. Social workers assess clients’ medical and psychosocial needs (address any urgent needs)
while linking the client to a medical case manager at a provider of their choice. At times, there is a
waiting list for MCM services in Philadelphia due to clients requesting MCM services from a provider
that is at capacity. CSU staff services to clients until that transition can be made or the client chooses to
go to an available MCM provider.
Considering the pervasive nature of poverty and other complicating factors in the lives of PLWH,
demand and need for medical case management are high. The EMA MMP sample showed 7.5% of PLWH
were not receiving medical case management. Three percent of the 2012 consumer survey respondents
reported needing medical case management services.
Transportation
PLWH’s transportation barriers vary by geographic location within the EMA. In rural and some suburban
areas, access to transit is limited or non-existent. Travel by public transit is time consuming and difficult
for individuals with limited mobility. Medicaid transportation is available for Medicaid-eligible clients but
consumers report barriers accessing it. Common challenges associated with Medicaid transportation are
the need to call to schedule a ride or transit day pass at least 10 days in advance, being picked up late or
not at all, and receiving transit day passes after the appointment time. Medicare-covered individuals
have reported that even with the discounted transit fares, they don’t always have the dollar necessary
for fare. RW transportation services are available to PLWH who do not have access to Medicaid or other
transportation services through tokens, transit passes and van service.
Transportation was reported as a need by 24% of PLWH who called into Central Intake in 2015.
Transportation needs were more common for women of child-bearing age (29%) and PLWH who were
recently incarcerated (33%). Participants in the OHP focus groups shared that time to travel to
appointments can be a barrier to attending appointments because taking public transit across the city or
into the suburbs can take an hour or two. In an informal survey of PLWH participating in the Positive
Committee (N=23), 45% reported missing medical appointments due to not having transportation. Of
those who reported problems with transportation to medical appointments, 50% reported moneyrelated problems, 38% reported that Medicaid rides were late, and 12% had challenges scheduling rides.
OHP conducted an online survey of RW medical case managers and social workers about their client’s
transportation needs and barriers (N=50). Thirty-four percent of the case managers reported that their
44
clients’ transportation needs were not being met. Problems with the contracted Medicaid provider were
mentioned by the majority of case managers. These problems included: long waits, late pick up, difficult
process, transit day passes arriving in the mail after appointments, and needing to schedule
transportation at least 10 days prior to appointment. Other barriers noted by case managers included
not having enough tokens on site to provide to clients who need them, policies barring giving tokens to
clients for non-medical appointments, clients not having money to pay for transportation fares, and
clients not having access to transit in their neighborhoods. Case managers expressed frustration with
the processes and the limited resources available to help them meet their clients’ transportation needs.
Dental Care
Dental care was noted as an unmet need by the respondents to the 2012 consumer survey. Of the
respondents, 26% reported not having dental insurance. Forty percent of respondents did not receive
dental care in the previous 12 months. Dental care was a need of 8.5% of PLWH calling into Central
Intake in 2015.
Questions about access to dental care come up frequently at the Positive Committee meetings. PLWH
report not knowing that they can receive free RW dental care services at local dental schools, as well as
free or low cost care at public health clinics. Another barrier to access is long waits for appointments at
these dental clinics. The wait for appointments for the dental school clinics can be several months long
due to high demand and periods of time when students are not available (summer and other breaks).
Providers and patients experience the same barriers to transportation to dental appointments as the
ones noted above. Many PLWH access dental services for urgent matters due to lack of understanding of
services available and lack of knowledge about oral health and living with HIV. Transitioning these
patients to comprehensive preventative dental care is often difficult due to short staffing of dental
offices, and a lack of dental case managers dedicated to this, as well as general lack of health literacy
around oral health.
Approximately half of the EMA’s RW clients receive Medicaid benefits, which cover basic preventative
and emergency care, with some limitations. Dental providers report that Medicaid coverage of specialty
care services is often approved when provided at educational institutions, but may not be in other
provider types. The gaps in access are a combination of lack of understanding by both providers and
consumers of available services within the EMA and a lack of insurance coverage for needed services.
Mental Health
The EMA estimates 13,289 PLWH in the EMA have mental illness, the majority with depression/anxiety
(79.1%), 11.7% with bipolar disorder, and 9.2% with psychosis. Individuals with both mental illness and
HIV represent a significant and vulnerable population. Between 2008 and 2010, 730 PLWH in the MMP
sample were interviewed, of which 358 (49.0%) indicated having received a mental illness diagnosis.
Patients with a mental illness diagnosis were more likely to be female, have Medicaid or Medicare as
their insurance, and either actively use or have a history of alcohol abuse and injection drug use.
Retention was similar between patients with and without a mental health diagnosis, with approximately
90% of patients satisfying retention criteria in either group. Adjusting for demographic and clinical
factors, there was no significant difference in retention or use of ART, but mentally ill patients were
45
significantly less likely to achieve viral suppression than patients who were not mentally ill. Rates of viral
suppression were lower for persons with depression/anxiety and psychosis but not bipolar disorder 61.
Blank et al. (2014) found that HIV prevalence (within samples from Baltimore and Philadelphia) was 4
times higher in a sample of people receiving mental health services than in the general population.
There was a positive association between psychiatric severity and HIV infection. 62 In the 2012 consumer
survey, 10% of respondents reported needing, but not receiving mental health counseling and other
services in the last 12 months, and 42% reported a met need for mental health services. According to
RW Central Intake, 45.2% of PLWH report a mental health disorder diagnosis at time of intake. During
the first half of 2015, 27% of PLWH reported need for mental health services at intake.
Substance Use
Substance use is a significant public health challenge in the EMA. Rates of substance use are high in the
EMA in the general population but are much more common in PLWH. EMA Behavioral Risk Factor
Surveillance System data indicates 9.9% of the population used illicit drugs in 2012. 63 Alcohol,
marijuana, cocaine, and heroin constituted 85.6% of primary drugs of choice reported at treatment
admissions in 2014. 64 All drug use is of concern when planning HIV prevention and treatment services.
Drug use affects an individuals’ ability to negotiate condom use, leads to sexual risk behaviors, and may
include sharing injection equipment. PLWH who use drugs are also less likely to adhere to treatment and
to maintain viral suppression, which increases their chances of exposing their sexual and drug using
partners to HIV.
Use and dependence on heroin and other opiates is an emerging concern in the EMA. Over the last few
years there have been increases in the amount of heroin and other opiates seized by law enforcement,
as well as increases in heroin and opiates-related overdose deaths and substance dependency
treatment admissions. In Philadelphia, between 2013 and 2014, treatment admissions for primary drug
use of heroin increased 1.6 percentage points, an increase of 3.2 percentage points from 2010. 65
Drug overdose deaths are increasing in the EMA, particularly among Whites and people 25-44. Half of all
drug overdose deaths in the EMA involve heroin. In Philadelphia, drug overdose deaths have increased
33% between 2013 and 2014. 66 There were 1,257 overdose deaths in the EMA in 2014: 655 in
Philadelphia, 425 in the Pennsylvania suburban counties, and 177 in the New Jersey suburban
Yehia, B.R., Stephens-Shield, A.J., Momplaisar, F., Taylor, L., Gross, R., Dube, B., Glanz, K. Brady, K. (August 2015). Health
outcomes of HIV-infected people with mental illness. AIDS and Behavior,1491-1500.
62
Blank, M.B., Himelhoch, S.S., Balaj, A.B., Metzger, D.S., Dixon, L.B., Rose, C. E., Oraka, E., Davis-Vogel, A., Thompson, W.W.,
Heffelfinger, J.D. A multisite study of the prevalence of HIV with rapid testing in mental health settings. American Journal of
Public Health, 104(12): 2377-2384.
63 Centers for Disease Control and Prevention (2014). Behavioral Risk Factor Surveillance System Survey Data [Data]. Retrieved
from http://www.cdc.gov/brfss/annual_data/annual_2012.html
64 Substance Abuse and Mental Health Services Administration. (2014). Treatment Admissions Data Set [Data]. Retrieved from
http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_web_table?t_state=PA
65 National Drug Early Warning System Sentinel Community Site Profile 2015: Philadelphia. August 2015.
http://ndews.umd.edu/sites/ndews.umd.edu/files/SCS%20Philadelphia%202015%20Final%20Web.pdf
66 Delaware Valley Intelligence Center (2015). Philadelphia Narcan Administration by Zip Code 01 January through 30 June 2015.
Retrieved from https://info.publicintelligence.net/DEA-PhiladelphiaOverdoses-2013-2014.pdf
61
46
counties. 67,68 Increases in overdose deaths in the EMA and nationwide are being driven by an increase in
the number of heroin users; high purity batches of heroin, which cause users to accidentally overdose;
an increase in new heroin initiates, many of whom are young and inexperienced; users of prescription
opioids initiating use of heroin which varies in purity, dosage amounts and adulterants; and the use of
highly toxic fentanyl and other adulterants.66
According to the analysis of the National Survey of Drug Use and Health, four out of five recent heroin
initiates (79.5%) previously used nonmedical pain relievers (NMPR) whereas only 1% of recent NMPR
initiates had prior use of heroin. Not all individuals who use prescription pain relievers will use heroin;
only about 4% will, and not all heroin users inject heroin. 69 According to 2013 TEDS data, approximately
70% of individuals in the EMA who were admitted into treatment for heroin dependence reported
injecting heroin. About 19% of all individuals admitted to drug treatment in the EMA reported injecting
any drugs.
Philadelphia has had a successful syringe exchange program for over 20 years. The syringe access
program includes substance use dependency treatment, medical care, social support, and referrals to
other services. PDPH estimates the PWID population (2010) of Philadelphia to be 37,378, with an HIV
case rate of 48.2 per 100,000. It is unclear how many PWID share injection equipment and how many
have increased risk from sexual behaviors like unprotected anal and vaginal sex. A recent analysis of
program data from this syringe access program found that, over the period of 1999 to 2014, new
registrants for the syringe exchange program have gotten more diverse, more geographically
concentrated, and younger over time. Notably, the proportion of Latino new registrants increased from
6.2% in 1999 to 25.4% in 2014. The proportion of people under 40 years of age increased from 11.3% to
58.7% in the same timeframe. 70
The EMA is concerned about the availability of syringe access in the suburban counties, outside of
Camden and Philadelphia Counties. In Pennsylvania, the distribution of syringes is technically illegal, but
several municipalities allow syringe access programs because of public health concerns. The EMA will
monitor access to substance use dependency treatment services, due to the high demand for treatment
for heroin and opioid dependence and limited available slots for the poor and uninsured. The EMA will
continue to monitor the data available regarding drug use and PWID; and target HIV prevention, testing,
and care services to the communities and subpopulations most in need.
PLWH and Substance Use
PDPH estimates that 10,414 PLWH in the EMA are substance users. Philadelphia MMP data for 2013
Stirling, S. (2015, June 12) N.J. heroin-related deaths rise for 4th straight year, up 155% since 2010. Retrieved from
http://www.nj.com/news/index.ssf/2015/06/nj_heroin-related_deaths_rise_for_4th_straight_yea.html
68 Drug Enforcement Agency. (November 2015) Analysis of Drug-related Overdose Deaths in Pennsylvania, 2014. Retrieved from
http://www.dea.gov/divisions/phi/2015/phi111715_attach.pdf
69 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (August
2013). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Retrieved from
http://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm
70 Maurer, L.A., Bass, S.B., Ye, D., Benitez, J., Mazzella, S., Krafty, R. (2016). Trend Analysis of Users of a Syringe Exchange
Program in Philadelphia, Pennsylvania: 1999-2014. AIDS Behavior. P 1-11. http://link.springer.com/article/10.1007%2Fs10461016-1393-y
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indicates that 14.2% of PLWH binge drink and 24.2% used illicit drugs in the last 12 months. Malta et al.
(2010) published a meta-analysis of studies assessing adherence to ART and a qualitative systematic
review of factors associated with better ART outcomes in HIV infected drug users. 71 Active drug use was
associated with worse ART adherence. Better ART outcomes were observed in former drug users, those
with less severe psychiatric conditions, those receiving opioid substitution therapy and/or psychosocial
support. The high rates of substance use among the HIV infected population require the development
and implementation of specialized services, which add cost and complexity to HIV care. Integration
between mental health, substance use dependency treatment, and HIV/AIDS prevention and care
services is necessary to meet the needs of those living with HIV/AIDS and those at high risk.
Housing Insecurity and Homelessness
Homelessness creates barriers to access, adherence, and continuity of care. Inability to store or access
medications, lack of routine medical care, poor nutrition, and the stress of being unstably housed affects
the course of HIV disease. PDPH estimates that there are 2,700 PLWH who are insecurely housed on an
annual basis in the EMA. A 2011 match of the surveillance registry and a sample of 592 homeless
persons found that 41 individuals or 6.9% of homeless persons were living with HIV or AIDS. The EMA’s
2012 consumer survey found that, of the 684 respondents, 3.9% reported living in a shelter or on the
street. Analysis of demographic data of persons in the EMA who received any Ryan White services in
2014 indicates that 10.1% of persons with known housing statuses were non-permanently housed.
In Philadelphia, the Office of Homeless Services has a Continuum of Care Board that addresses
homelessness in a number of populations, including people with HIV/AIDS. Their Point in Time Count
(conducted on January 29, 2014) identified 5,738 homeless persons in Philadelphia. 72 Of these, 104 were
people known to be living with HIV; 82 of these homeless PLWH were sheltered on the night of the
count. The Continuum of Care Board’s housing inventory cites a need for 3,909 year-round permanent
supportive housing beds. 73 It is important to note that the Point in Time Count only includes homeless
people in the city and not in the surrounding areas. In addition, this is according to the strict United
States Department of Housing and Urban Development’s Final Rule Defining Homelessness and does not
include those clients who are unstably housed. 74
Consistently, PLWH mention Housing as an unmet need. Half of the PLWH report housing assistance as a
need at Ryan White Central Intake. Women of child bearing age (59%) and PLWH who were recently
71
Malta M., Magnanini M.M., Strathdee S.A., Bastos F.I. (2010). Adherence to Antiretroviral Therapy among HIV-infected Drug
Users: A Meta-Analysis. AIDS Behavior, 14(4):731-47.
72 City of Philadelphia, Office of Supportive Housing (2015). Philadelphia Continuum of Care 2014 Point in Time Summary
[Data]. Retrieved from http://www.phila.gov/osh/PDF/Philadelphia_CoC_2014_Point_inTimeCount.pdf.
73 City of Philadelphia, Office of Supportive Housing (2015). Philadelphia Continuum of Care 2014 Housing Inventory Chart.
Retrieved from http://www.phila.gov/osh/PDF/Philadelphia_CoC_2014_Housing_Inventory.pdf.
74 (1) Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an
individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a
place not meant for human habitation immediately before entering that institution;
(2) Individuals and families who will imminently lose their primary nighttime residence;
(3) Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who
do not otherwise qualify as homeless under this definition; or
(4) Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault,
stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.
48
incarcerated (53%) are even more likely to report housing needs. Twenty-seven percent of the 2012
Consumer Survey respondents reported needing housing services.
EMA resources are unable to meet current housing needs of PLWH in the EMA. As of January 2016 there
were approximately 695 households supported with Housing Opportunities for People with AIDS
(HOPWA) funds in Philadelphia and Delaware County, PA. The waiting list for HOPWA housing was
approximately 350 people. In New Jersey suburbs, the Department of Planning & Development Division
of Housing Services administers a HOPWA housing voucher program assisting 90 clients in 2016. As of
this plan, there were about 60 people on that waiting list.
Permanent housing programs are limited in Philadelphia. The waiting list for the Housing Choice
Voucher Program (formerly known as Section 8) has not been open in Philadelphia since 2010, and the
waiting list will not reopen until the majority of those applications are served. 75 The current wait is
estimated to be ten years, and there are over 100,000 people on the wait list.
Risk Behaviors Associated with Insecure Housing
People experiencing homelessness and housing insecurity are more likely to engage in sexual and drug
using risk behaviors than housed individuals. Kidder et al. (2008) found that people experiencing
homelessness were far more likely to have ever or recently engaged in substance use and HIV
transmission risk behaviors. 76 Even after controlling for predicted confounding factors, housing status
remained a significant predictor of the number of sex partners in the past 12 months, sex exchange
(both lifetime and in last 12 months), unprotected sex with unknown status partners and all drug and
alcohol use variables. A study on social instability and HIV risk in low income urban women found that
homelessness was the only indicator consistently associated with multiple sex partners, sex exchange,
and recent STI diagnosis in controlled models. 77 Men in the OHP focus groups who had been homeless
said that while in active addiction they did not care about their health or STI or HIV prevention and
would do what was necessary to secure drugs and/or survive.
Sex Education
The state of Pennsylvania does not require comprehensive sexuality education in its schools, only HIV
prevention with a focus on abstinence. Individual school boards make decisions on sexual education
within their districts, including whether to teach it at all. This is true in Philadelphia as well as the rest of
the state. By contrast, New Jersey requires that school districts provide comprehensive health
education, including a “Human Relationships and Sexuality” curriculum.
Philadelphia Housing Authority (2015). Housing Choice Voucher Waiting List Update. Retrieved from
http://www.pha.phila.gov/pha-news/pha-news/2015/hcv-waiting-list-application-update.aspx.
76 Kidder, D. P., Wolitski, R. J., Pals, S. L., Campsmith, M. L. (2008). Housing status and HIV risk behaviors among homeless and
housed persons with HIV. Journal of Acquired Immune Deficiency Syndrome, 00(0), 1-5.
77 German, D., Latkin, C.A. (2012). Social stability and HIV risk behavior: Evaluating the role of accumulated vulnerability. AIDS
Behavior, 16(1), 168-178.
75
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The CDC’s School Health Profiles describe mandatory health-related curricula in secondary schools by
state and urban area. 78 The 2014 survey included questions about whether each of sixteen HIV, STD, and
pregnancy prevention topics were taught as a part of a required health course. The topics included basic
information such as how to obtain condoms, the importance of limiting the number of sexual partners,
and how HIV and other STDs are transmitted. Only 11.4% of Pennsylvania schools, 19.2% of Philadelphia
schools, and 24.7% of New Jersey schools required all sixteen topics.
Secondary education provides the broadest opportunity to engage the general population of the EMA.
This inconsistency in school health and sexuality education results in an uneven platform for
dissemination of information about HIV/AIDS, risk behaviors, and healthy relationships.
Gaps in Service as Reported by Consumers
2015 Client
Services Unit –
Need at Intake
(N=1011)
2013 MMP
(N= 191)
2012 Consumer
Survey Respondent
Identified Need
(N=700)
Service
%
%
%
Dental
7
29
14
37
>90
24
29
8
7
2
2
2
3
3
11
10
5
1
24
26
50
5
5
8
5
7
27
8
1
4
29
-
9
17
0.5
-
19
-
2
2
-
Benefits Assistance
Case Management
Medications
Mental Health
Support groups/Peer
Support
Transportation
Food
Housing
Substance Abuse
Treatment
Medical Care
HIV Education/Risk
Reduction
Treatment Adherence
Home Health Care
Z. Demissie, N.D. Brener, T. McManus, S.L. Shanklin, J. Hawkins, L. Kann (2015). School Health Profiles 2014, Characteristics of
Health Programs Among Secondary Schools. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention. Retrieved from
http://www.cdc.gov/healthyyouth/data/profiles/pdf/2014/2014_profiles_report.pdf.
78
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c. Identified Barriers to HIV Prevention and Care Services
Barriers to HIV prevention, screening, and care services are myriad and vary from interpersonal and
individual psychosocial factors to systemic social factors like poverty and HIV stigma. The EMA utilizes
every available resource and mechanism to mitigate and eliminate these barriers, yet many persist.
Individuals at high risk for HIV and PLWH face many competing pressures and needs that complicate and
compromise their abilities to practice risk reduction behaviors, access prevention services, get an HIV
test, attend medical appointments, and adhere to treatment regimens. For these reasons, the EMA
ensures access to medical care and a wide variety of support services through a coordinated and
comprehensive system of services funded through local, state, private, and federal grants.
The following lists offer brief descriptions of the most important barriers and challenges to the EMA
achieving the NHAS goals.
Social and Structural Barriers 79
•
•
•
•
•
Poverty, especially entrenched deep poverty
Racism, often in conjunction with and/or because of poverty, is one of the drivers of health
disparities among Black and Latino populations in the EMA. This racism may be perceived
racism, structural racism, or interpersonal racism. Racism also manifests in racial segregation,
which impacts individuals’ and communities’ abilities to access services and resources.
Gender inequality limits women’s ability to negotiate condom use and practice other harm
reduction strategies. Many women with HIV and at greater risk for HIV are survivors of
interpersonal violence and adult and childhood sexual trauma. These traumatic experiences may
interfere with their abilities to engage in healthcare and practice healthy behaviors.
LGBTQ stigma and discrimination pervade society, even with the legal advances of the last
decade. Fear of stigma and discrimination based on one’s sexual orientation or gender
presentation can be a powerful barrier to accessing healthcare. This stigma is institutionalized in
many regards, especially considering Pennsylvania does not have a legal protection against
employment, housing, or other discrimination for LGBTQ individuals.
HIV stigma prevents people from accessing HIV testing and prevention services and from
engaging in appropriate health care. HIV stigma manifests in interpersonal, familiar, medical and
other public settings.
The social and structural barriers listed in this section are powerful and intersecting forces in HIV risk and health disparities.
This section has been kept brief in order to aid readability. It is assumed the reader has a basic understanding of how social
determinants influence HIV risk and health. For more information about social determinants of HIV risk refer to:
Centers for Disease Control and Prevention. Social determinants of health among adults with diagnosed HIV in 11 states, the
District of Columbia and Puerto Rico, 2013. HIV Surveillance Supplemental Report 2015;20(No. 5):
http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport-vol20-no5.pdf Published November 2015.
Dean, H. and Fenton, K. Addressing the social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis,
sexually transmitted infections, and tuberculosis. Public Health Reports. 2010. 125(Suppl 4): 1–5. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882967/
Office of HIV Planning. Where we live matters: Social determinants of HIV risk. 2013
http://www.slideshare.net/HIVPhilly/where-we-live-matters-january-2013-update-57848626
Maps of many of the social determinants for the 9 counties of the EMA can be found on the Office of HIV Planning website on
the Documents page: http://hivphilly.org/documents.html
79
51
•
•
•
•
•
Mass incarceration affects community and individual-level risk for HIV on multiple levels that
include limiting the number of adult males within a community, concentrating HIV within the
incarcerated and recently incarcerated populations, practicing risk behaviors while incarcerated
due to policies banning or limiting access to condoms and other harm reduction tools, and
policies and laws denying individuals employment and other opportunities due to criminal
history.
Lack of affordable housing within the City of Philadelphia is a pervasive problem for the whole
community, not just those living with HIV. There is also a lack of federal, state, and local
resources to combat the problem. The pervasive nature of poverty makes this lack of housing
resources even more acute to the most vulnerable communities.
Lack of perceived risk of HIV can be found in various subpopulations, including minority
heterosexual communities. Lack of perceived risk often leads to lax condom use, other sexual
risk behaviors, and not seeking HIV screening.
Medical mistrust is common among Black, Latino and other minority communities. Medical
mistrust leads to individuals not seeking primary care and prevention services, as well as not
adhering to treatment regimens.
Lack of community knowledge about pre-exposure prophylaxis (PrEP) and other HIV prevention
services impedes the full implementation of this necessary biomedical intervention.
Legislative and Policy Barriers
•
•
•
•
Sexuality education varies in the EMA’s public school systems, and often focuses on abstinence
and contraception with little to no information relevant to students who do not identify as
heterosexual or are gender non-conforming. In both New Jersey and Pennsylvania, sexually
transmitted infections and HIV/AIDS education is required, but the methods and curriculum are
decided by the local school board and individual schools. Sexuality education is required in New
Jersey but not Pennsylvania.
Syringe access barriers exist in the EMA because of state laws and federal funding restrictions on
the purchase of syringes. In New Jersey and Pennsylvania, syringe distribution for the purpose of
use of illicit drugs is illegal. Within the EMA, there are only two syringe exchange programs, a
multi-site program in Philadelphia (city-funded) and Camden city. Syringes can be purchased in
pharmacies without a prescription (at the discretion of the pharmacist) throughout the EMA.
Federal funding restrictions limit the EMA’s ability to provide PrEP to appropriate high-risk
individuals. Ryan White funds and CDC HIV prevention funds cannot pay for medications for
PrEP use or the accompanying laboratory tests. Pharmaceutical patient assistance programs do
not provide funds for laboratory tests required for PrEP management. This limits the EMA’s
ability to ensure PrEP access to the most at-risk population. Patients wanting to start PrEP often
have burdensome paperwork, waiting, and “red tape” to deal with before insurance will cover
medications. If the EMA could provide starter packs of medications to individuals, more people
could start PrEP immediately.
Different laws about HIV laboratory reporting requirements hinder PDPH’s ability to properly
plan for the whole EMA, compare outcomes geographically, and to target programs and
52
•
•
•
resources appropriately. There are also significant reporting delays, which prevent planning in
real time.
Pennsylvania’s “super protected data” policies, which cover mental health status, HIV status,
and drug and alcohol treatment, hinder coordination within the state’s various programs.
Pennsylvania law considers it a felony for a person living with HIV to engage in sex work, even
when using condoms and/or the activity cannot transmit HIV. New Jersey law criminalizes “an
act of sexual penetration without the informed consent of the other person” by anyone who
knows they are HIV positive. These laws impact the decisions PLWH make around disclosure and
sexual behaviors. Neither state laws consider whether the intent was malicious or if
transmission occurred or was likely to occur.
Law enforcement may consider an individual carrying condoms as a sign of prostitution. This
discourages sex workers from using condoms.
Health Department Barriers
•
PDPH experiences challenges in coordinating between several health departments. These
challenges range from differences in the type of surveillance data collected and timing of release
of those data to differences in priorities, laws, and policies between jurisdictions. The
differences in the types of data collected limit the ability of PDPH to develop EMA-wide Care
Continuums and to compare the outcomes across the regions.
Program Barriers
•
•
•
•
Due to PA and NJ confidentiality laws and differences in reporting requirements and methods,
real time coordination of services on the client and provider levels are hindered. Written
releases are required for any HIV-related information to be shared between providers.
Lack of adequate funding to provide affordable short-term and permanent housing for PLWH
and those at high risk for HIV. Federal, state, and local funds cannot meet the demand.
Some medical providers are uninformed about PrEP, which leads to reluctance to prescribe PrEP
to their patients. Many medical practices do not know how to bill for PrEP-related services and
advocate for patients who want to initiate PrEP. Local AETC has been offering tailored training
about PrEP implementation to clinics and medical providers, which has increased provider
acceptability and implementation of PrEP. More work and funding are needed to fully
implement PrEP throughout the EMA.
Medical providers’ reluctance to offer routine HIV testing to their patients is a barrier to full
implementation of routine testing. Providers’ reluctance stems from lack of perceived risk for
patients, reluctance to discuss sexuality and risk behaviors, perception that HIV testing will be
time consuming, and lack of knowledge about third-party billing.
Service Provider Barriers
•
53
Lack of participation of insurers and state Medicaid offices in planning prevents a full
understanding of how the public and private insurance programs provide for the needs of PLWH
and those at risk. Coordination and integration of services would improve with participation
from these payers.
Client Barriers
•
•
•
•
•
•
•
•
•
Most of the EMA’s PLWH and individuals most at risk for HIV are living in or near poverty.
Poverty affects every aspect of an individual’s life and well-being, including limiting access to
healthcare and prevention services.
Lack of reliable transportation is a common problem for people throughout the EMA. Transit
does not run in many suburban and rural parts of the EMA. Those who live near transit lines may
not have the money to pay fares. The PA Medicaid transportation provider is unreliable. Travel
times to appointments via transit or Medicaid transportation can take hours, which limits
individuals’ abilities to keep appointments.
Many PLWH and those at risk lack access to needed behavioral and mental health services due
to lack of insurance coverage for needed treatment, workforce capacity issues, shortage of
inpatient and outpatient treatment slots, and lack of integration of these services in primary
care.
Non-English proficiency is a barrier for various cultural and ethnic communities within our
diverse EMA. Even if language interpretation and translation are available at service providers,
many people are unaware of these or do not feel comfortable seeking healthcare and other
services outside of their own communities. Printed health education materials are often only
distributed in English.
Many of the individuals at greatest risk for HIV experience stigma, discrimination and violence
due to their gender, race, sexual orientation, and/or socio-economic status. Populations most
vulnerable to the compounding impact of these intersectional identities are young men of color
who have sex with men, Black men and women living in poverty, Latinas and Latinos, and Trans
women of color. The trauma experienced by these individuals and communities must be
addressed in order to provide comprehensive healthcare. These experiences of trauma impact
the individual’s ability to trust providers, access health care, and protect themselves from HIV
and other health risks.
Many PLWH and those at high risk are living with chronic and complex health concerns like
diabetes, asthma, heart disease, viral hepatitis, mental health diagnoses, and substance use
dependency. These co-morbidities require holistic and comprehensive care. Co-morbidities can
also complicate HIV treatment through physiology and an individual’s behaviors and health
literacy about their various conditions.
Housing instability and homelessness affect many PLWH and those at risk. Without adequate
housing, it is difficult to maintain HIV treatment and continue healthy behaviors. Those who are
insecurely housed may engage in risky sexual behaviors to secure housing. Affordable housing is
scarce in the EMA, and the public housing programs are unable to meet demand.
Low health literacy affects individuals’ abilities to understand and adhere to treatment
regimens.
Fear of law enforcement and or other federal, state or local authorities prevents some
individuals from seeking healthcare and other services; for example, undocumented immigrants,
sex workers, drug users, and individuals with a history of incarceration.
54
E: Data Access, Sources, and Systems
a. Data Sources and Systems
The data used in this plan, the integrated epidemiologic profile, and HIV planning draw on a wide variety
of sources. Regular review of data is fully integrated into the planning process. For example, the annual
RWPC allocations process draws on the most recent epidemiologic data, service cost data, local
consumer survey data, and more. The integrated epidemiologic profile compiles much, but not all, of
this data. This plan, including the epidemiologic overview, draws on that information and adds further
contextual information when appropriate. The primary data sources included in local HIV planning needs
assessments, as well as this plan, are below.
PDPH and National Data Sources
•
•
•
•
•
•
•
•
•
•
55
United States Census Bureau
o American Community Survey: Information regarding general population, race, ethnicity,
poverty, insurance status, education, and employment
o Research on Americans who are likely transgender
Bureau of Justice Statistics: Information on state imprisonment rates and HIV/AIDS mortality
Pennsylvania Uniform Crime Reporting System: Drug-related arrest data
Centers for Disease Control and Prevention
o Youth Risk Behavior Survey: Survey data on risk behaviors of high school students,
including drug and alcohol use and sexual behaviors
o Behavioral Risk Factor Surveillance System: Survey data on risk behaviors of adults,
including drug and alcohol use and sexual behaviors
o Wide-Ranging Online Data for Epidemiologic Research (WONDER): Deaths attributed to
HIV disease
Health Resources and Services Administration
o Health Professional Shortage Areas: Data regarding employment and shortages of
health professionals; used heavily in the Resource Inventory
Substance Abuse and Mental Health Services Administration
o National Survey on Drug Use and Health: Data on serious mental illness and drug use
o Treatment Episode Data Set – Admissions: Data on drug of choice and method of
administration by demographic for people admitted to rehabilitation programs
Philadelphia Housing Authority: Information about housing, homeless, and HIV, including pointin-time counts and general estimates
Medical Monitoring Project: Local data on the medical care and needs of people living with HIV
National HIV Behavioral Surveillance: Local HIV behavioral risk data for men who have sex with
men, people who inject drugs, and high-risk heterosexuals
Local and state health departments
o HIV surveillance: New diagnoses, prevalence, and demographic data
o STD surveillance
o PDPH/AACO Client Services Unit: Requests at client intake, barriers to service, client
demographics
o
o
o
o
o
o
o
o
HIV prevention
Vital statistics
CAREWare: Client-level data
Unduplicated client-level service utilization data
Ryan White Services Report data
Incidence estimates (where available)
Quality management reports
HRSA/HAB and PDPH/AACO performance measures
These data sources are augmented by published peer-reviewed research and comprehensive reports
from various organizations, including the National Alliance to End Homelessness and The Pew Charitable
Trust.
OHP Research
OHP assesses access to services, gaps, and barriers through a consumer survey every five years. The
survey relies on Ryan White providers to randomly sample 25% of their clients, and asks questions about
demographics, health status, barriers to care, and service priorities. In 2012, 3,500 surveys were
distributed, and there were 700 responses. The next consumer survey will be conducted in 2016/2017.
In 2014, OHP held focus groups about general access to healthcare with young men who have sex with
men and heterosexuals of low socioeconomic status. These focus groups provided new contextual
information about individual experiences with the healthcare system that impact target populations’
access to and interactions with healthcare and HIV testing.
In addition, OHP regularly uses geographic analysis to illustrate social determinants of health, inform
planning decisions, and augment other data sources. OHP also conducts small-scale exploratory surveys
as necessary in order to identify needs for further investigation.
b. Policy Facilitators and Challenges
One of Philadelphia’s greatest assets in HIV data availability is the coordination of HIV funding under
PDPH’s AIDS Activities Coordinating Office (AACO). As a RW Part A recipient, RW Part B regional subrecipient, and a directly-funded CDC HIV prevention recipient, PDPH’s AACO has access to a
comprehensive compendium of information about people who use HIV-related services in the region.
This enables a thorough view of people living with or at risk for HIV who are a part of PDPH’s HIV service
system.
In order to augment this information, the Planning Council and HPG use many different data sources.
While this provides a broad basis for HIV planning that includes several social determinants of health, it
also necessitates using sources with different methods, variables, classifications, reporting, and
coverage areas.
When using outside data sources, the geographical area is often ambiguous. The Philadelphia
Metropolitan Statistical Area (MSA) is defined in several ways, and may include 11 counties in 4 states, 9
counties in 2 states (as seen in the EMA), 5 counties in 1 state, or another variation, depending on the
source. The definition used in any given report is not always clear. There are also situations where a
56
county within the EMA is excluded by a data source. For example, Behavioral Risk Factor Surveillance
Survey data is available for the 5-county Philadelphia MSA and a 3-county Camden MSA, but the latter
excludes Salem County. In other cases, additional counties are included, as seen in the 7-county
Southern New Jersey region in the National Survey on Drug Use and Health. The lack of uniform
aggregate data standards across federal data sources, particularly as they pertain to geographic area,
creates a challenge to planning for the EMA.
In addition, the Philadelphia EMA falls under two state health departments and one city health
department. Each health department has a different structure, collects different data, and reports on
different variables. This is the case for both HIV data and other categories of data. Furthermore, each
releases data on a different schedule, which often involves a lengthy reporting delay.
The most significant policy challenge in developing the HIV Care Continuum in particular is the lack of
comparable data from Pennsylvania and New Jersey. The City of Philadelphia has full electronic
reporting of CD4 and viral load data. However, Pennsylvania only requires reporting for CD4 counts
below 200 and detectable viral loads. In Pennsylvania, CD4 counts over 200 and undetectable viral load
reports are not reported. Meanwhile, New Jersey requires reporting for all viral loads as well as CD4
counts below 200, and it only recently implemented electronic lab reporting. Consequently, a
comprehensive HIV Care Continuum for the entire EMA is not currently possible.
Finally, one of the biggest barriers to effective data-informed service planning is maintaining compliance
with Pennsylvania’s strict HIV confidentiality laws. Surveillance-driven interventions have been
demonstrated as effective strategies in many jurisdictions, but the Philadelphia EMA must use
workarounds to implement these types of interventions. However, PDPH has identified many strategies
to implement surveillance-assisted programs while complying with confidentiality laws; this can be seen
in START Care, CoRECT, and HIV surveillance-assisted Partner Services referrals.
c. Unavailable Data
There is limited information available on the general population of certain risk groups. For example,
detailed data on factors like income and insurance is not available by sexual orientation, which makes it
difficult to analyze differences between men who have sex with men and the general population. This is
even more difficult for persons who are transgender, since data related to gender identity is rarely
collected, and certainly not on a population level. The lack of availability of population estimates and
demographics for those populations creates a major difficulty in planning services. Likewise, risk
behaviors (such as illicit drug use) are often underreported. This impacts planning for prevention service
delivery, but also affects available information on mode of HIV transmission. Additionally, there is
limited information on PrEP uptake, particularly for privately-insured patients; data on patients on PrEP
in the region would be useful in prevention service planning.
57
Section II: Integrated
HIV Prevention and
Care Plan
A: Goals and Objectives
The Philadelphia Integrated HIV Prevention and Care Plan is the result of the collaborative effort of the
Philadelphia Ryan White Part A Planning Council, the Philadelphia HIV Prevention Planning Group, and
the Philadelphia Department of Public Health, AIDS Activities Coordinating Office to engage service
delivery providers, people living with HIV, persons at higher risk for HIV infection, and other community
stakeholders. The EMA has demonstrated a sustained commitment to HIV service system integration,
funding coordination, quality management, and planning since the community first responded to the
needs of people with AIDS more than three decades ago.
In keeping with the National HIV/AIDS Strategy (NHAS), the EMA’s continuum of care has been built
around various strategies for ensuring access to high quality and comprehensive HIV screening,
prevention and care services that mitigate social, structural, economic, and personal barriers. The
following goals and objectives were developed in keeping with the NHAS goals and objectives, and with
the understanding of the local epidemic and social and structural barriers existent within the EMA.
The plan uses the NHAS target populations, as well as locally identified target populations. The NHAS
populations include:
•
Gay and bisexual men and other men who have sex with men of all races and ethnicities (MSM)
•
Black women and men
•
Latino men and women
•
Transgender women
•
People who inject drugs
•
Youth ages 13-24
Activities that address and or support components of the care continuum have been shown in bold
within the various activities throughout this section.
58
Goal 1: Reduce new HIV infections
Objective 1.1: Increase the proportion of people who know their HIV status
Strategy 1.1.1: Promote adoption of opt-out routine HIV screening in a variety of healthcare settings
Timeline
Responsible Parties Activities
Target Population
Data Indicators
By the
end of
2021
PDPH and partners
By the
end of
2021
Clinical providers
Health care facilities
Provide training on
third-party billing
and integrating
routine HIV
screening into
patient flow
Implement site
appropriate routine
HIV screening
policies
Clinical providers
Health care facilities
TA units delivered
People aged 13 to
65
# of HIV tests in
healthcare settings
# of new HIV
diagnoses in
healthcare settings
Strategy 1.1.2: Offer targeted HIV screening and education particularly among gay and bisexual men and
other men who have sex with men (MSM), transgender persons, high risk heterosexuals, and people who
inject drugs (PWID)
Timeline
Through
the end of
2021
Responsible Parties
Community-based
providers
PDPH-funded
providers
CDC-funded
providers
Through
the end of
2021
PDPH
Community-based
providers
Through
the end of
2021
Philadelphia County
Prison Health
Services
PDPH
59
Activities
Community
outreach and
provision of the
best testing
technology for the
site, including 4th
generation testing
where feasible
Ongoing geographic
and performance
analysis of test sites
to improve
targeting
Offer opt-out HIV
screening at intake
Target Population
NHAS populations
EIIHA populations
People who are
experiencing
homelessness
Data Indicators
# of communitybased tests
NHAS populations
EIIHA populations
People who are
experiencing
homelessness
Persons
incarcerated in
Philadelphia County
jails
HIV positivity rate
HIV positivity rate
# of new HIV
diagnoses
# of community
testing sites
# of HIV tests in jails
# of positive tests
Strategy 1.1.3: Offer timely screening and linkage to care to sexual and drug using partners of PLWH
Timeline Responsible Parties Activities
Target Population
Data Indicators
Through HIV clinical
Refer all diagnosed Diagnosed PLWH
# of referrals to
the end
providers
PLWH to partner
partner services
of 2021
HIV testing
services
providers
Health care facilities
Through PDPH
Use surveillance
Diagnosed PLWH
# of referrals to
the end
data to trigger
partner services
of 2021
partner services
Through DIS – PA
Provide HIV and STI Sexual and drug
# of partners of
the end
Department of
screening to
using partners of
PLWH tested
of 2021
Health (PADOH), NJ identified partners
PLWH
Department of
of PLWH
# of partners of
Public Health
PLWH identified
(NJDPH),
PDPH
Objective 1.2: Reduce the number of new HIV infections
Strategy 1.2.1: Ensure condom access and promote condom use
Timeline Responsible Parties Activities
Target Population
Through PDPH
Continue
MSM
the end
PADOH
widespread access
High risk
of 2021
NJDPH
to condoms through heterosexuals
public schools,
Youth aged 13-24
community-based
Trans women
providers and mail
order
By end of PDPH
Utilize social media
Young MSM,
2021
to (re)normalize
sexually active
condom use
youth, adolescent
through Do You
users of social
Philly website
media, general
targeting young
public
MSM of color, free
mail order condom
distribution
program, and
adolescent website,
Take Control Philly
By end of PDPH
Develop social
Young MSM
2021
marketing campaign
to promote use of
condoms
Data Indicators
# of condoms
distributed
# of condom
distribution sites
Social media metrics
as available
Number of condoms
distributed through
mail order requests
Metrics of use of
condoms collected
through surveys
TBD.
60
By the
end of
2021
PDPH
Implement a new
performance
measure related to
condom use in both
care and prevention
systems
Diagnosed PLWH
and people
accessing targeted
testing services
Strategy 1.2.2: Ensure the provision of PrEP and nPEP to at-risk populations
Timeline Responsible parties
Activity
Target Populations
By the
PDPH
Coordinate EMAHigh risk HIVend of
PDPH-funded
wide provision of
individuals
2021
providers
PrEP and nPEP
PWID
NJDPH
Trans women
PADOH
Black women
Latinas
MSM
Youths 13-24
By the
PDPH
Develop and
High risk HIVend of
implement a plan to individuals
2021
inform the public
PWID
about the
Trans women
availability of PrEP
Black women
and nPEP
Latinas
MSM
Youths aged 13-24
Condom use at last
sexual encounter
Data Indicators
NHBS survey data
# of people
accessing publiclyfunded PrEP, and
nPEP
NHBS survey data
Strategy 1.2.3 Ensure equitable access to syringe access services, substance use treatment and related
harm reduction services
Timeline Responsible Parties
Activities
Target Population
Data Indicators
By the
RWPC
Expand syringe
PWID
# of syringe access
end of
HPG
access services
PLWH with opioid
sites
2021
PDPH
throughout the EMA dependency
Substance use
# of syringes
service providers
exchanged
By the
end of
2021
By the
end of
2021
61
RWPC
HPG
PDPH
Substance use
service providers
RWPC
HPG
PDPH
Substance use
service providers
Expand access to
medication-assisted
treatment for opioid
dependency
throughout the EMA
Expand access to
and capacity of
substance use
treatment
throughout the EMA
PWID
PLWH with opioid
dependency
# of treatment
referrals
PWID
PLWH with opioid
dependency
# of treatment
referrals
# of RW SA units
provided
Strategy 1.2.4: Reduce the amount of HIV virus within communities
Responsible parties
Activity
Target Populations
Timeline
Through PDPH
Ensure equitable
PLWH
the end PADOH
access to ARVs
of 2021 NJDPH
RWPC
Medical case
management
providers
Through
the end
of 2021
PDPH
PADOH
NJDPH
RWPC
Clinical providers
Support treatment
adherence activities
PLWH
Strategy 1.2.5: Eliminate perinatal transmissions throughout the EMA
Timeline Responsible parties
Activity
Target Populations
Through PDPH
Continue the HIV
HIV+ pregnant
the end
Fetal and Infant
women
of 2021
Mortality Review
HIV+ women
process in
HIV exposed infants
Philadelphia to
improve health
outcomes for HIV+
women and HIVexposed infants
Through Clinical providers
Promote perinatal
HIV+ pregnant
the end PDPH
medical case
women
of 2021
management
HIV+ women who
program
want to become
pregnant
Data Indicators
# of ADAP clients
Percentage of
diagnosed PLWH on
ARVs
MMP indicator
related to ARV Rx
HAB measure – 06
PHL measure - 03
Data Indicators
# of cases reviewed
# of
recommendations
implemented by
Community Action
Board
# of women referred
to perinatal case
management
# of perinatal case
management clients
62
Strategy 1.2.6: Identify persons with acute HIV infection and immediately link them to HIV care
Responsible parties
Activity
Target Populations
Data Indicators
Timeline
Through PDPH
Promote the
NHAS populations
# of acute infections
the end Hospitals
implementation of
People aged 13 to
identified
th
of 2021 Health care provider 4 generation HIV
65
organizations
testing
# of 4th generation
tests
Through
the end
of 2021
Clinical providers
PDPH
Medical case
management
providers
Testing sites
Ensure immediate
linkage to HIV care
and ARVs
Newly diagnosed
people with acute
HIV infection
# of 4th generation
testing sites
% of newly
diagnosed people
with acute HIV
infection
immediately linked
to care
Strategy: 1.2.7: Reduce the percentage of youth, including gay and bisexual men who engage in HIV-risk
behaviors
Timeline Responsible parties
Activity
Target Populations
Data Indicators
By the
PADOH
Promote
Students in public
YRBS
end of
PDPH
comprehensive,
schools
2021
NJDPH
culturallySchool Health
School districts
competent sexuality
Education Profiles
within the EMA
education that
includes and
addresses the needs
of LGBTQ youth
By the
PDPH
Create online
Young MSM of color # of condom
end of
campaign Do You
requests
2017
Philly to encourage
Social media and
condom use, HIV
website analytics
testing, and PrEP
uptake in
Philadelphia
Through PDPH
Continue condom
Youth aged 13-24
# of condoms
the end Philadelphia high
distribution program
distributed
of 2021 schools
and Take Control
Philly campaign
# of condom
requests
63
Anticipated challenges and barriers to Goal 1 include:
•
•
•
•
•
•
•
•
•
•
•
Access to PrEP is complicated by high cost, burdensome paperwork, and lack of community
and provider knowledge/comfort.
Sexuality education is not mandated in PA schools. Local school districts decide what
curriculum and sexuality content are taught in schools, which leads to inconsistent or nonexistent sexuality education in public schools.
Individual-level barriers complicate immediate linkage and treatment adherence like drug
use, poverty, mental health, lack of insurance, homelessness, etc.
There is a lot competition for young people’s attention via social media and online campaigns.
Access to prenatal care is a challenge to women living in poverty due to a variety of causes
like lack of adequate number of providers in some communities and complicating personal
factors including drug use, mental illness, and domestic violence.
Philadelphia Public schools allow STD testing, but not HIV testing, within schools. Including
HIV testing would allow for the opportunity of early diagnosis and treatment, as well as
referral to appropriate risk reduction interventions.
Healthcare facilities must change internal administrative practices to adopt routine screening
and develop mechanisms to bill third party payers.
Reaching at-risk populations requires providing culturally competent and culturally
appropriate services at non-traditional times and locations.
Providing health services in prison/jail settings requires partnership and collaboration.
Prisoners with HIV may be released without notice or adequate linkage to community-based
care.
Partner services requires trust in public health personnel to maintain confidentiality with
sensitive personal information.
Resources
To achieve the objectives related to this goal, multiple funding sources will be coordinated to maximize
available resources, including CDC (HIV prevention), Ryan White (Parts A, B, C, D and MAI), public and
private insurance, and City General Revenue funding. (See Coordination of Services and Funding in
Section I. C. a. i.)
64
Goal 2: Increase access to care and improve health outcomes for people living with HIV
Objective 2.1: Increase the percentage of newly diagnosed persons linked to HIV medical care
within 30 days of diagnosis
Strategy 2.1.1: Reduce individual and programmatic barriers to care
Timeline
Responsible parties Activity
Target Populations
Through
PDPH
Continue
Newly-diagnosed
the end
NJDPH
development and
PLWH
of 2021
PADOH
delivery of
evidence-based
PLWH never linked
(and informed) and to care
protocol driven
linkage services
including navigation
services such as
CoRECT, DIS Linkage
Services and NJ
Clinical navigation
programs
Through
PDPH
Expand access to
PLWH
the end
PADOH
supportive services
of 2021
NJDPH
that enable timely
RWPC
linkage to care,
including
transportation and
psycho-social
support
Strategy 2.1.2: Reduce systemic barriers to timely linkage to care.
Timeline Responsible parties Activity
Target Populations
Through PDPH
Continue to support NHAS populations
the end
NJDPH
a range of coof 2021
PADOH
located HIV testing
and clinical services
By the
PDPH and health
Develop protocols
NHAS populations
end of
care providers
for immediate
2021
linkage to care for
persons who test in
community settings
65
Data Indicators
# of navigation
services clients
# of successfully
linked navigation
clients
Related HAB
measures for gap in
HIV medical care
Data Indicators
# of co-located
testing and clinical
sites
# protocols /MOU
developed
Strategy 2.1.3: Promote access to Ryan White services for newly-diagnosed individuals
Timeline Responsible parties
Activity
Target Populations
Data Indicators
Through PDPH
Disseminate
Non-Ryan White
# of TA units
the end Mid-Atlantic AETC
information about
clinical providers
of 2021 NJ AETC
RW services for
Hospitals
newly-diagnosed
individuals
Through PDPH
Continue provision
PLWH
# clients linked to
the end RWPC
of centralized
medical case
of 2021
medical case
management
management intake
Objective 2.2: Increase the percentage of people with diagnosed HIV infection retained in care
Strategy 2.2.1: Reduce individual barriers to retention in HIV care
Timeline Responsible parties
Activity
Target Populations
Through PDPH
Continue co-located PLWH
the end NJDPH
clinical and
of 2021 PADOH
supportive services,
RWPC
including mental
RW providers
health, substance
use treatment, and
medical case
management
Through RW clinical providers Provide ongoing
PLWH
the end PDPH
assessment of
of 2021
behavioral health
needs of patients in
HIV clinical providers
and linkages to
appropriate services
Through PDPH
Provide data-to-care PLWH who have
the end
activities including
fallen out of care
of 2021
CoRECT and ARTAS
to find and reengage
clients to care who
have been lost to
care.
Data Indicators
# of provider sites
with co-located
services
HAB measures – 21
and 23
# clients re-linked to
care
# clients with
durable viral
suppression
66
Strategy 2.2.2: Reduce programmatic and provider barriers to retention in HIV care
Timeline Responsible parties
Activity
Target Populations
By the
PDPH
Ensure all RW
RW clients
end of
RW providers
services are
2021
RWPC
linguistically and
Mid-Atlantic AETC
culturally competent
NJ AETC
and LGBTQ affirming
By the
PDPH
Promote adoption of RW providers
end of
RW providers
trauma-informed
2021
RWPC
approaches
Mid-Atlantic AETC
NJ AETC
Through PDPH
Support vigorous
RW providers
the end Mid-Atlantic AETC
pursuit of health
of 2021 NJ AETC
insurance
enrollment of all
eligible RW clients
Strategy 2.2.3: Reduce systemic barriers to retention in HIV care
Timeline Responsible parties
Activity
Target Populations
By end
RWPC
Develop a plan to
PLWH
of 2017 PDPH
address
documented
barriers to retention
in care, including
transportation
Spring
PDPH
Determine the most RW clients
2017
RWPC
efficient, costPADOH
effective, and
feasible mechanism
to provide health
insurance costsharing assistance
67
Data Indicators
CSU grievance data
TA units
Consumer survey
data
TA units
Quality
Improvement Plans
(QIP)
TA units
# of enrolled RW
eligible clients
Data Indicators
Plan completed
Assessment
completed
Objective 2.3: Increase the percentage of people with diagnosed HIV infection who are virally
suppressed
Strategy 2.3.1: Reduce individual barriers to treatment adherence
Timeline Responsible parties
Activity
Target Populations
Through PDPH
Ensure access to
PLWH
the end
PADOH
food banks and
NHAS populations
of 2021
NJDPH
other food services.
RWPC
Philadelphia
Department of
Housing and
Community
Development (DHCD)
Through PDPH
Provide high
PLWH
the end
quality medical
of 2021
case management
which develops and
individualized plan
to address
adherence with
clients
Strategy 2.3.2: Reduce individual barriers to ART
Timeline Responsible parties Activity
Through PDPH
Vigorously pursue
the end
RW providers
health insurance
of 2021
PADOH
and ADAP
NJDPH
enrollment for
eligible clients
Through
the end
of 2021
PDPH
RWPC
Minimize
interruptions to
ART adherence
through provision
of emergency
pharmaceutical
assistance
Target Populations
PLWH
Data Indicators
# of RW food bank
units
CSU intake data
about food needs
HAB measures – 01
and 02
PHL - 03
Data Indicators
# of insured RW
clients
# of SPBP/ADAP
clients
PLWH
# of Rx units
dispensed
# of emergency
pharmaceutical
assistance clients
68
Strategy 2.3.3: Reduce systemic barriers to ART
Timeline Responsible parties
Activity
Through PDPH
Support
the end PADOH
comprehensive
of 2021 NJDPH
ADAP formulary,
including access to
Hepatitis C
treatment
Target Populations
PLWH
Data Indicators
% of FDA approved
treatment regimens
on the formulary
Objective 2.4: Increase the percentage of PLWH retained in HIV care who are stably housed
Strategy 2.4.1: Continue to support homelessness prevention activities
Timeline Responsible parties
Activity
Target Populations
Through PDPH
Provide direct
RW clients
the end RWPC
emergency financial
of 2021
assistance for rent,
mortgage, and
utilities
Data Indicators
# of DEFA units
# of DEFA clients
Strategy 2.4.2: Continue and expand access to transitional and long term housing for PLWH
Timeline Responsible parties
Activity
Target Populations
Data Indicators
By the
PDPH
Increase EMA
PLWH
# of HOPWA housing
end of
RWPC
capacity to house
slots
2021
DHCD
homeless and
PADOH
housing-insecure
# of RW-funded
NJ Dept of
PLWH
transitional housing
Community Affairs
units
By the
end of
2017
PDPH
RWPC
Investigate
feasibility of RW
funded Housing First
project
PLWH experiencing
homelessness
Completion of
feasibility report
Strategy 2.4.3: Provide services that combat economic and individual barriers to housing
Timeline Responsible parties
Activity
Target Populations
Data Indicators
Through PDPH
Ensure medical case RW client
Quality
the end MCM providers
managers assess and
management data
of 2021
address housing
instability when
developing and
reviewing care plan
69
Anticipated challenges and barriers to Goal 2 include:
•
•
•
•
•
•
•
•
•
•
•
•
•
Individuals often have competing needs and complicating factors that must be addressed for
successful linkage to care.
Lack of perceived risk for HIV persists in some communities, which may prevent people from
accessing HIV testing services.
It is difficult to get information about services to the most at-risk individuals and communities
because of medical mistrust and lack of engagement in primary care.
There are many factors associated with an individual reaching viral suppression, including
individual biology and co-morbid conditions.
Costs of medications are ever-changing and can be very expensive. Access to generic drugs is
limited due to patent laws. ADAP and other EMA formularies may need to adjust to meet needs
and available resources.
Health insurance enrollment is voluntary. Some individuals will choose not to participate.
Individuals have competing needs and priorities that may interfere with their ability to attend
appointments and access health care services.
Communities most at risk for HIV are often also communities that have experienced trauma at
the community and individual levels, which complicates their ability to trust medical care
providers and access services.
Implementation of trauma-informed services is complex and requires significant resources
(financial, human, and otherwise), which might not be available to every provider organization.
Implementing health insurance cost-sharing assistance is complex and will require significant
financial resources.
The availability of affordable housing is limited in the EMA, especially in Philadelphia.
Current resources cannot meet the demand for housing for PLWH.
Maintaining housing can be difficult to PLWH with substance use dependency and severe mental
illness.
Resources
To achieve the objectives related to this goal, multiple funding sources will be coordinated to
maximize available resources, including CDC (HIV prevention), Ryan White (Parts A, B, C, D and
MAI), public and private insurance, and City General Revenue funding. (See Coordination of
Services and Funding in Section I, C., a. i.)
70
Goal 3: Reduce HIV-related disparities and health inequities
Objective 3.1: Reduce HIV related disparities in new diagnoses among high-risk populations
Strategy 3.1.1: Increase access to services that address social determinants of HIV risk
Timeline Responsible parties
Activity
Target Populations
Data Indicators
By the
PDPH
Provide prevention
HIV-negative MSM
# of navigation
end of
Navigation services
navigation services
of color
clients
2021
provider
to HIV-negative high
risk individuals in
# of linkages to
Philadelphia
behavioral health
and social services
Through
the end
of 2021
PDPH
Through
the end
of 2021
PDPH
RW MCM providers
RWPC
PADOH
NJDPH
Through
the end
of 2021
RWPC
PDPH
HPG
71
Develop and sustain
the Philadelphia
1509 Collaborative
to implement
comprehensive HIV
prevention and care
services for MSM of
color
Provide culturally
competent medical
case management
services in clinical
and communitybased settings
throughout the
EMA.
Monitor access to
and availability of
substance use
treatment and
mental health
treatment
Collaborative
partners
Number of MOUs
and collaborative
protocols developed
PLWH
NHAS populations
# of MCM clients
# of MCM providers
HAB/AACO
measures:
HAB – 01 and 02
PHL-02
PLWH
CSU intake data
MMP unmet need
data
RW program data
Strategy 3.1.2: Increase access to biomedical prevention interventions
Timeline Responsible parties
Activity
Target Populations
By the
PDPH
Ensure the provision NHAS populations
end of
PADOH
of PrEP and nPEP to
2021
NJDPH
at risk populations
By the
end of
2021
PDPH
Provide prevention
navigation services
that link MSM of
color to PrEP and
provide ongoing
adherence support
Continue and
expand community
education activities
about PrEP
Through
the end
of 2021
PDPH
Through
the end
of 2021
PDPH
Mid-Atlantic AETC
NJ AETC
Continue and
expand clinical
education about
PrEP
Through
the end
of 2021
PDPH
RWPC
PADOH
NJDPH
Support a
comprehensive and
geographically
diverse RW care
system to ensure
access to ARVs and
treatment
adherence services.
MSM of color
Data Indicators
# of providers
prescribing PrEP
NHBS data
# referrals
# linkages to PrEP
MSM of color
Community leaders
High risk
heterosexuals
Sexual and drug
using partners of
PLWH
PWID
Trans women
Primary care
providers
# of community
education events
PLWH
% of RW clients
virally suppressed
15-09 data
# of TA units
72
Strategy 3.1.3: Assess local disparities along the Prevention Continuum
Timeline Responsible parties
Activity
Target Populations
Through PDPH
Assess systemic and NHAS defined and
the end
provider level
local identified
of 2021
disparities in the
populations
care and prevention
continuum
Through PDPH and provider
Develop quality
NHAS defined and
the end
partners
improvement
local identified
of 2021
projects to address
populations
identified disparities
Data Indicators
Reports on
disparities at the
provider and
systemic level
QIP
Objective 3.2: Reduce disparities in viral suppression
Strategy 3.2.1: Continue RW-funded activities to link and retain MSM of color, youth aged 13 to 24,
transgender women, and other NHAS populations
Timeline Responsible parties
Activity
Target Populations
Data Indicators
Through PDPH
Ensure quality
MSM of color
QIP
the end RW clinical providers improvement efforts Youth aged 13 to 24
of 2021 RW MCM providers
to address
Trans women
RWPC
disparities along the NHAS populations
Care Continuum in
RW clinical and
MCM services
Through PDPH
Ensure clinical and
Black MSM
Population-specific
the end RW clinical providers support services
Latino MSM
Care Continuums
of 2021 RW MCM providers
that address the
Latinas
RWPC
unique needs and
Black women
life experiences of
Trans women
disproportionately
LGBTQ youth
affected populations Youth aged 13-24
PWID
People experiencing
homelessness
73
Strategy 3.2.2: Encourage the provision of trauma-informed services that provide affirming and culturally
competent care for transgender women, women of color, MSM of color, PWID, people experiencing
homelessness and people with limited English-proficiency and health literacy
Timeline Responsible parties
Activity
Target Populations
Data Indicators
Through PDPH
Ensure clinical and
Black MSM
Population-specific
the end RW clinical providers support services
Latino MSM
Continuums
of 2021 RW MCM providers
address the unique
Latinas
RWPC
needs and life
Black women
Provider reports on
experiences of
Trans women
disparities
disproportionately
LGBTQ youth
affected populations Youth aged 13-24
PWID
People experiencing
homelessness
Through PDPH
Support training and Clinical providers
# of TA units
the end Mid-Atlantic AETC
technical assistance MCM providers
of 2021
on trauma-informed
care
Strategy 3.2.3: Increase access to clinical, pharmaceutical, and other services that address co-morbid
conditions, including but not limited to viral hepatitis and STIs
Timeline
Responsible
Activity
Target
Data Indicators
parties
Populations
Through the
PDPH
Increase access to
PLWH with
# of ADAP clients who
end of 2021
PADOH
hepatitis C
hepatitis C
receive HCV treatment
NJDPH
treatment
Clinical
NJ and PA Medicaid
providers
eligibility for Hepatitis C
treatment
By the end of PDPH
Increase STI
Sexually-active
O/AMC HAB measures –
2021
RW clinical
screening at RW
RW clients
13,15,17
providers
funded sites
PHL- 02, 04
74
Anticipated challenges and barriers to Goal 3:
•
•
•
•
•
•
Mistrust of medical providers within communities at most-risk for HIV
Hepatitis C treatment is very expensive. Current resources cannot meet the need for all PLWH
who are co-infected. Access to treatment through public and private insurers may be limited
and contingent on health status and other factors.
Trauma and discrimination is a common experience for PLWH, which complicates their care
engagement and ability to adhere to treatment.
The most difficult to engage patients have complex social, medical, and economic needs that
cannot be met through the RW system.
PrEP access and uptake are not equitable. Paperwork for patient assistance programs and
insurance coverage is often burdensome and delays initiation.
HIV stigma and lack of perceived risk persist in many communities.
Resources
To achieve the objectives related to this goal, multiple funding sources will be coordinated to
maximize available resources, including CDC (HIV prevention), Ryan White (Parts A, B, C, D and
MAI), public and private insurance, and City General Revenue funding. (See Coordination of
Services and Funding in Section I, C. a. i.)
75
Goal 4: Achieve a more coordinated response to the HIV epidemic 80
Objective 4.1: Support collaboration, communication and coordination across all sectors
Strategy 4.1.1: Continue coordination of resources
Timeline Responsible parties
Activity
Through PDPH
Continue centralized
the end
grant administration
of 2021
of RW Parts, CDC,
and other local
funds for HIV
prevention and care
services in the EMA.
Target Populations
NA
Data Indicators
NA
Strategy 4.1.2: Continue outreach and education to clinical providers outside the RW system
Timeline Responsible parties
Activity
Target Populations
Data Indicators
Through PDPH
Educate and update Clinical providers
TA units
the end Mid-Atlantic AETC
clinical providers
of 2021 NJ AETC
throughout the EMA
on the most current
evidence-based
guidelines and
protocols, including
but not limited to
routine HIV
screening and PrEP
provision
80
Many of the activities under Goal 4 do not have target populations or data indicators because of the nature of
the activity, particularly those related to increasing collaboration and coordination with integrated planning
partners and stakeholders. See Section III for detailed discussion about how these activities will be monitored.
76
Strategy 4.1.3: Continue and expand efforts to make relevant public data accessible, useful and usercentered
Timeline Responsible parties Activity
Target Populations Data Indicators
By the
OHP
Develop and
RW providers
Product launch
end of
implement a HIV
PLWH
2017
services resource
Social workers
inventory database Clinical providers
for public use
People seeking HIV
prevention services
Health navigators
Through OHP
Develop and
RWPC
NA
the end
disseminate
HPG
of 2021
materials that are
Federal partners
accessible, usable, Local stakeholders
and audiencePADOH
centered using
NJDPH
both traditional
County health
and digital
departments
methods to
PLWH
support informed
RW providers
community
HIV prevention
planning
providers
Through OHP
Improve efforts to HPG
Planning body
the end
PDPH
provide HPG and
RWPC
survey results
of 2021
PADOH
RWPC with timely, stakeholders
NJDPH
accurate, and
accessible data to
inform decisionmaking
Objective 4.2: Facilitate collaboration, communication and coordination in integrated planning
activities
Strategy 4.2.1: Foster relationships between health departments within the EMA
Timeline Responsible parties Activity
Target Populations
By the
OHP
Hold a meeting of
PDPH
end of
integrated planning NJDPH
2017
partners to further
PADOH
collaboration,
HPG co-chairs
communication, and RWPC co-chairs
coordination
NJ HPG co-chairs
PA HPG co-chairs
77
Data Indicators
# of meetings
# of attendees
Strategy 4.2.2: Increase integration, communication and collaboration amongst the existing planning
bodies
Timeline Responsible parties Activity
Target Populations
Data Indicators
Through OHP
Continue
NA
NA
the end
PDPH
participation in
of 2021
relevant regional
meetings and events
Through OHP
Explore
NA
NA
the end
PDPH
opportunities for
of 2021
RWPC
further integration
HPG
of the RWPC and
Philadelphia HPG
Strategy 4.2.3: Support community and stakeholder participation in integrated planning activities
Timeline Responsible parties Activity
Target Populations
Data Indicators
Through OHP
Support the
PLWH
# PLWH who attend
the end
RWPC
activities of the
Positive Committee
of 2021
PDPH
Positive Committee
meetings
HPG
and other avenues
of PLWH
RWPC membership
participation in
data
integrated planning
activities and RW
service prioritization
and resource
allocations.
Through OHP
Develop, implement RWPC
NA
the end
PDPH
and disseminate
HPG
of 2021
RWPC
results of needs
PLWH
HPG
assessment
Federal partners
activities as
County health
necessary and
departments
required
Local stakeholders
Through OHP
Engage stakeholders Local stakeholders
NA
the end
PDPH
and community
PLWH
of 2021
RWPC
members by using
RWPC
HPG
traditional and
HPG
digital methods,
including but not
limited to language
interpretation and
translation
78
Anticipated challenges and barriers to Goal 4 include:
•
•
•
•
•
•
Legal barriers to data sharing between providers, health departments, etc.
Inconsistencies in lab reporting laws across the EMA hinder data coordination and comparison.
Stakeholders have different, and sometimes competing, priorities and requirements.
Some stakeholders needed for truly collaborative and coordinated planning do not have the same
urgency to engage in those types of activities, e.g. private insurance companies and other divisions in
city and state governments.
Geographic distance, travel costs and other logistical concerns may hinder in-person meetings.
Language interpretation and translation services are costly and require several business days to
arrange.
Resources
To achieve the objectives related to this goal, multiple funding sources will be coordinated to
maximize available resources, including CDC (HIV prevention), Ryan White (Parts A, B, C, D and
MAI), public and private insurance, and City General Revenue funding. (See Coordination of
Services and Funding in Section I, C., a. i.)
79
B: Collaborations, Partnerships and Stakeholder
Involvement
a. Stakeholder Contributions
The Philadelphia EMA Ryan White Planning Council and the HIV Prevention Planning Group are both
comprised of consumers and providers of services, including many PLWH. The members of these
planning groups reflect the community that they serve to ensure that the decisions made by the
planning bodies are in the best interest of individuals receiving HIV prevention and care services. The
planning activities of both groups have benefited from PDPH representatives at committee meetings
and the ongoing participation of staff of the Pennsylvania Department of Health, New Jersey
Department of Public Health, Mid-Atlantic and New Jersey AIDS Education and Training Centers (AETC),
and the regional HRSA office. Community members regularly attend community planning meetings,
participate in needs assessment activities, and provide feedback through formal and informal methods.
Comprehensive Planning is one of five Planning Council committees. The Comprehensive Planning
Committee makes recommendations on integrated planning and RW service provision based on
available data. The committee also sets the Ryan White Part A service priorities in accordance with local
epidemiological, needs assessment, and service utilization data. The objectives, strategies, and activities
in this plan are a result of the work of this committee and that of the Needs Assessment Committee, in
conjunction with other community stakeholders, HPG, OHP, and PDPH.
The Needs Assessment Committee of the RWPC reviews epidemiological data and research, in addition
to developing needs assessment activities and tools. The Needs Assessment Committee collaborates
with PDPH, medical providers, and consumers to develop surveys about service needs, barriers, linkage
and retention to care, and service provision.
The Philadelphia HIV Prevention Group (HPG) is composed of HIV prevention providers, PLWH,
community members, and other stakeholders. Over the last year, the HPG provided feedback to the
PDPH on PrEP implementation, as well as helped to develop a list of providers prescribing PrEP to
patients. The HPG hosted a panel of young men who were currently taking PrEP. The panel provided the
HPG members and prevention providers in attendance an opportunity to engage with the young men
about their experiences taking the medication, the reactions from their friends and families, and their
experiences with paying for PrEP.
The Office of HIV Planning (OHP) provides the administrative and technical support for the HIV
Prevention Planning Group and RWPC. OHP responsibilities include: assessing community needs through
a variety of methods, including qualitative and quantitative research activities, conducting community
outreach and educational activities, writing comprehensive plans, recording and monitoring official
processes (including meeting minutes), collaborating with the PDPH AIDS Activities Coordinating Office
(AACO) and other community and governmental organizations, and providing logistical and
administrative support to the planning bodies. The OHP maintains an active presence at community
meetings, which allows information to be shared easily. OHP staff currently participates in the
Pennsylvania HIV Planning Group, the EMA’s quarterly Outpatient Ambulatory Care Quality
80
Improvement meetings, the Suburban HIV/AIDS Coalition (SHAC), Philadelphia HIV FIMR, the
Philadelphia School District sexual health materials review committee, and the New Jersey HIV Planning
Group. OHP staff shares information from these meetings through staff reports at community planning
meetings and formal presentations from stakeholders.
b. Gaps in Stakeholder Participation
The EMA’s planning process would benefit from the regular participation of representatives from the
private insurers within the region and New Jersey and Pennsylvania Medicaid departments. Over time,
multiple invitations and inquiries have been made to invite participation from these important
stakeholders, but without any long-term change. OHP and PDPH will continue to provide the best
available information about public and private insurance coverage to the RWPC and HPG, as well as
continue to find ways for these stakeholders to provide valuable input into service planning and
delivery.
The RWPC and HPG are reflective of the EMA’s epidemic and the communities most at risk. The groups
strive to be inclusive and representative of the varied and diverse communities they serve. Recently, the
groups have been working to incorporate the participation and feedback from youth and young adults
into their work through participation of youth stakeholders in meetings, as well as through means like
focus groups and surveys. At the time of this plan, there are plans to increase youth participation in the
Positive Committee and HPG through establishing relationships with trusted providers of youth services
to help identify and recruit young people to become attendees or members of these groups.
c. Letter of Concurrence
See attachment for Letters of Concurrence to the goals and objectives of this plan from the co-chairs of
the Philadelphia Ryan White Planning Council and the Philadelphia HIV Prevention Planning Group in
Appendix B: Letters of Concurrence.
81
C: People Living with HIV and Community Engagement
a. Community participation in plan development
Community input is integrated into the planning process. Memberships of the Council, HPG, and their
respective committees reflect the demographics of the local HIV/AIDS epidemic, including geographical
considerations. All planning activities and meetings are open to the public, inclusive, and evidencebased. Great care is taken to assure that deliberations consider the needs of historically underserved
populations, persons who are unaware of their HIV status, and consumers who have been lost to care.
Direct input from the community is provided by planning body members, members of the Positive
Committee, various needs assessment activities, consumer surveys, and three resource allocations
processes for Ryan White Part A services (one for each of the three sub-regions of the EMA: City of
Philadelphia, the four Pennsylvania counties, and the four New Jersey counties). Additional input from
the community augments these mechanisms, including analysis of OHP Ryan White consumer survey
data, utilization reports from consumers of Ryan White services gathered by PDPH’s Client Services Unit,
and a formal feedback process available to consumers through the region’s information and referral and
client services hotlines.
b. PLWH and community participation in plan development
Approximately half of the members of RWPC are PLWH. PLWH members and non-members of RWPC
participate in the decision-making processes and regularly attend RWPC meetings. RWPC and HPG share
the Positive Committee, which has supported the engaged and informed participation of PLWH in all
community planning activities for over a decade. The committee meets monthly on relevant topics,
including training on epidemiological data, service provision, and how to best participate in planning
meetings. The committee also advises OHP on consumer surveys and other needs assessment activities.
Members of the committee often bring up emerging needs and other issues for further discussion and
investigation by RWPC and HPG.
In 2015 a group of Spanish-speaking PLWH began participating in Positive Committee meetings. Positive
Committee meeting minutes are translated in Spanish and distributed at meetings and posted on the
OHP website (along with the meeting materials in English). Interpretation services are available for any
RWPC and HPG meeting, provided adequate notice is provided. Spanish interpretation services are
regularly provided at the Positive Committee.
c. Methods for community engagement
The RWPC, HPG, PDPH and OHP work together to design mechanisms to collect community and
consumer needs and challenges. These mechanisms include regular monthly meetings of the community
planning bodies with time allotted for public comment and participation. Meeting times and locations
are advertised on the OHP website and updated paper meeting calendars are distributed at every
meeting. OHP supports community participation through transportation cost reimbursement and
refreshments at meetings. OHP has taken other steps to make information about community planning
and RW services available to Spanish-speaking and other non-English speaking community members,
82
including adding Google translate to the OHP website and publishing the Positive Committee’s
consumer FAQ brochure in Spanish. OHP hired a bilingual receptionist in 2015 to increase access to OHP
activities and meetings to Spanish-speaking community members.
d. Community insights and solutions
Community input is the norm in the EMA’s planning activities with an active PLWH committee, diverse
and reflective RWPC and HPG, and ongoing needs assessment activities. Some recent examples of how
community input helped identify health problems and develop solutions are included here; however,
this entire planning document is the result of the critical insights provided by the community. In 2015,
the topic of transportation as a barrier to HIV medical care was brought to the attention of RWPC during
allocations deliberations by Positive Committee members. OHP conducted a survey for providers to
assess barriers related to transportation services, including Medicaid transportation as a result (see
Section I.D for a more detailed discussion). In 2014, OHP conducted focus groups with YMSM and
heterosexuals of low socio-economic status to learn more about their healthcare and HIV testing
experiences and preferences. PLWH and those at risk for HIV participated in those focus groups, and
their contributions are included in this plan (see Section I D). Issues related to information dissemination
and knowledge of RW services among Spanish-speaking PLWH were raised in Positive Committee
meetings. OHP and PDPH have worked with these consumers to address their individual and
community-level barriers to health information and needed services.
83
Section III: Monitoring
and Improvement
Process for updating planning bodies and stakeholders
Given the diversity of the EMA, coordination between internal and external stakeholders and the PDPH
(the recipient), RWPC, and HPG is critical to creating a cohesive strategy for the implementation of the
integrated plan. PDPH solicits input from external stakeholders and consumers, which helps to
determine priorities and inform the plan’s monitoring and improvement activities. RWPC receives
regular updates from PDPH staff on program implementation, RW expenditures and underspending,
outcome data, and clinical quality management (CQM) activities. PDPH staff attend all RWPC meetings,
and OHP staff attend PDPH’s regional CQM meetings with subrecipients. RWPC and HPG receive annual
updates from the PDPH Medical Director/Epidemiologist, which includes the EMA’s Care Continuum.
AACO’s Client Services Unit Manager reports Central Intake data and RW program data to the RWPC
annually, and PDPH’s Information Services Manager participates in the RWPC’s Comprehensive Planning
Committee meetings throughout the year to ensure full use of CQM data in the planning process. The
RWPC’s Comprehensive Planning Committee receives data from PDPH and reviews the integrated plan,
provides feedback, and monitors progress annually.
Progress on plan implementation is reported to a number of stakeholders. These stakeholders include
federal, state, and local governments, funding agencies such as HRSA and CDC, the RWPC and HPG, the
Philadelphia Health Commissioner’s Office, consumers, the Pennsylvania Department of Health, and
subrecipients. PDPH reports its CQM activities and progress to HRSA twice a year in writing through the
progress report and annual application, and submits reports to the Pennsylvania Department of Health
on a regular basis. In addition to site visits and written reports, the recipient participates in the National
Quality Center (NQC) Regional Group QM Meetings for RW Part C/D programs.
OHP and PDPH attend community meetings to share updates and provide information on planning and
program activities, as well as to solicit feedback from stakeholders. OHP maintains a website with all
meeting minutes and materials, planning documents, and presentation slides. OHP also uses social
media, a blog, and an email newsletter to inform the community and stakeholders about planning
activities and to solicit feedback. Input on CQM activities related to the integrated plan is obtained from
subrecipients at regional QM meetings. Consumer feedback is obtained through PDPH’s Client Services
Unit, the consumer input required as a component of subrecipients’ quality improvement projects, the
RWPC which has 50% consumer representation, and the Positive Committee. The Positive Committee
84
supports the role of consumers of HIV services in planning and decision-making activities through
regular trainings, special educational presentations, and group discussion. PDPH and OHP staff attend
the PA HPG and participate in its committees. Information is shared between the EMA’s planning bodies
and the PA HPG through OHP staff. OHP staff work with PA HPG support staff to coordinate planning
efforts and share data. OHP staff and RWPC members attend the NJ HPG. The HPG’s Governmental CoChair provides regular updates on PDPH’s HIV prevention activities and implementation of programs and
an annual update on HIV prevention programs and related PDPH activities. The Integrated Executive
Committee meets quarterly to review the activities and goals of the planning bodies and to receive
updates from PDPH and OHP on program implementation, strategic planning, and other activities.
Monitoring and evaluation of goals and objectives
Monitoring and evaluation of the implementation of the strategies and objectives of the integrated plan
primarily occurs through the EMA’s CQM program, which includes defined indicators across the
continuum of care. The objectives and goals of the plan are closely aligned with the National HIV/AIDS
Strategy (NHAS). The EMA’s plan is coordinated with planning activities and embedded in the recipient’s
administrative activities, which include procuring and monitoring a multi-agency system that impacts all
stages of the care continuum through the provision of HIV care and prevention services. All of the CQM
activities that PDPH undertakes fall within one or more of these domains, and are supported by efforts
to promote a culture of clinical quality at all levels of the system based on defined service standards,
performance measures, client- and system-level outcomes, and high quality data for decision-making,
planning, program monitoring, and service procurement. PDPH utilizes a comprehensive and cohesive
process for quality management. This process includes the regular and systematic monitoring of
provider services, defined performance measures for all service categories, uniform documentation and
reporting, regular analysis and feedback to subrecipients, quality improvement at both the provider and
system levels, dissemination of results and best practices in regional and individual meetings with
subrecipients, and capacity building.
85
Program Measures by Service Category
Performance Measure
PHL01 Two or More Viral Load Counts
PHL02 MSM Receiving Syphilis Screening
PHL03 Gonorrhea Screening
PHL04 MSM Receiving Gonorrhea Screening
PHL05 Cervical Cancer Screening
PHL06 Colposcopy After Abnormal Pap
HAB01 Viral Load Suppression
HAB02 Prescription of ART
HAB03 HIV Medical Visit Frequency
HAB04 Gap in HIV Medical Visits
HAB05 PCP Prophylaxis
HAB06 Adherence Assessment
HAB07 Hepatitis B Vaccination
HAB08 Hepatitis C Screening
HAB09 HIV Risk Counseling
HAB10 Lipid Screening
HAB11 Syphilis Screening
HAB12 TB Screening
HAB13 Chlamydia Screening
HAB14 Hepatitis B Screening
HAB15 Influenza Vaccination
HAB16 Mental Health Screening
HAB17 Substance Use Screening
HAB18 Service Care Plan
HAB19 Dental and Medical History
HAB20 Dental Treatment Plan
HAB21 Oral Hygiene Education
O/AMC
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
MCM
X
X
X
Other
Core
Support
X
X
X
X
X
X
X
X
X
X
PDPH monitors the degree to which providers adhere to the service provisions that define the
administrative and programmatic requirements for each service category. Process monitoring is
conducted to measure the extent to which programs are implemented as planned. This includes
monitoring of numbers of clients served, numbers of services provided, and the target populations
reached. In addition, performance standards are defined for all service areas. These standards are based
on Public Health Service (PHS guidelines) for medical care for PWLH, other federal guidance such as the
Morbidity and Mortality Weekly Report (MMWR) for prevention with positives, and professional and
locally developed guidelines. The service provisions describe requirements for staff training and
accreditation, service procedures, documentation, reporting, and participation in the EMA’s CQM
86
initiatives. These standards are promulgated in Requests for Proposals and continuation funding
processes and incorporated into contracts. Through this investment in quality assurance, the recipient
evaluates progress toward impacting the care continuum through the implementation of siteappropriate routine screening policies in healthcare settings, the utilization of 4th generation HIV testing,
protocols for immediate linkage to care for people who test in community settings, documentation of
the vigorous pursuit of insurance enrollment, and the provision of services that address psychosocial
barriers to medical retention and medication adherence in the integrated plan. These services are
regularly and systematically monitored through chart reviews and data extraction from CAREWare and
EvaluationWeb. Progress toward goals is evaluated at prescribed intervals, and contextualized in
quarterly provider narratives and chart reviews. Another component of quality assurance is the
recipient’s formal grievance process, which responds to objectives in the EMA’s Comprehensive Plan
calling for an efficient process to handle consumer conflicts and concerns with their services and to
analyze trends for use in planning.
Outcomes monitoring and evaluation tracks performance with respect to client outcomes. The
outcomes are derived from PHS guidelines and professional standards. In addition to client-level
outcomes, the EMA’s integrated plan incorporates the monitoring of systems- and provider-level
outcomes related to NHAS goals and the continuum of care. PDPH also monitors an array of defined
performance outcomes delineated in the integrated HIV care and prevention plan that include STI
screenings, condom use, women’s health and preconception counseling, behavioral health, social
determinants of HIV risk, accessibility of services, insurance enrollment, and disparities among
subpopulations. Defined performance measures for all service categories are primarily documented in
CAREWare, while outcomes related to prevention are calculated from reports generated from
EvaluationWeb and through PDPH’s surveillance unit. CAREWare and EvaluationWeb allow the recipient
to readily collect, combine, interpret, and provide feedback in a diverse system, and these standardized
tools facilitate capacity building. PDPH regularly collects this data and provides feedback reports to
subrecipients to inform and prioritize quality improvement projects (QIPs).
Continuous quality improvement (CQI) focuses on translating this data to action by solving problems to
improve processes and the overall system, and to ensure delivery of exceptionally high quality clinical
services and customer satisfaction. CQI links to outcomes evaluation and performance management in
that low performance for an outcome is one factor that triggers the recipient initiating a CQI plan. CQI
includes the collection of annual quality improvement projects (QIPs) and quarterly updates from
prevention and care subrecipients. CQI projects are required of all funded providers. Providers are
encouraged to use the FOCUS PDSA model for QI activities. 81 Regional priorities determine whether
QIPs are directed at one measure or if they are based on whether a provider is meeting the performance
threshold(s) for targeted measure(s). PDPH collects QIPs on a quarterly basis and provides detailed
feedback to subrecipients on all QIPs and quarterly updates. Dissemination of CQI results and best
practices occurs at regional QM meetings between PDPH and its subrecipients. These meetings provide
81
For examples and instructions on the FOCUS PDSA model see the Agency of Healthcare Quality and Research
website: http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacytoolkit/healthlittoolkit2-tool2b.html
87
a forum for providers to present QI strategies and tools, and for content experts to provide best
practices in service delivery. PDPH also disseminates results to a joint meeting of the RWPC and HPG,
and provides updates on progress towards the goals.
Improvement activities at the systems level are primarily directed by the PDPH’s Continuum Workgroup.
The Continuum Workgroup consists of PDPH’s HIV Program Director, Program Implementation
Administrator, Medical Director, unit managers, and supervisors. The committee is scheduled to meet
weekly to review data and coordinate activities around the care continuum. The Continuum Workgroup
serves as PDPH’s CQM committee for HIV care and prevention services and oversees progress toward
achieving the goals outlined in the integrated plan. The Comprehensive Planning Committee and the
Integrated Joint Executive Committee work with PDPH to review outcomes and plan implementation of
activities and programs.
Strategy to use surveillance and program data to improve
health outcomes
The Comprehensive Planning Committee uses the EMA Care Continuum to plan RW service priorities
and inform RWPC Part A allocation decisions. RWPC and HPG regularly review RW program, prevention
system, surveillance, and local epidemiological data to determine which activities will best improve
health outcomes for PLWH and reduce incidence in the EMA. OHP uses program and surveillance data to
inform the development of needs assessment activities. These data help the RWPC and HPG identify
emerging trends and community needs. OHP provides a compendium of data for the RWPC Part A
allocations process that includes program, epidemiological, and other data to ensure allocations
decisions meet community needs and improve health outcomes.
PDPH employs a multifaceted approach to epidemiologic and surveillance data for prevention program
planning and evaluation. The recipient’s Medical Director/Medical Epidemiologist represents the HIV
Surveillance Unit at weekly Continuum Workgroup meetings and provides updates on the most recent
epidemiologic and surveillance data. The Continuum Workgroup consists of HIV surveillance, program,
and evaluation leadership. Its scope encompasses HIV care and treatment programs (Ryan White Part A
and B in Philadelphia), CDC, State, and locally funded HIV prevention programs. The Workgroup
develops strategies for improving outcomes throughout the HIV continuum of care. The Workgroup
reviews program data, incidence and prevalence data, Medical Monitoring Project data, and data from
the National HIV Behavioral Surveillance project conducted in Philadelphia. Other relevant data, such as
information on disparities in care and access, are also reviewed. Select HIV Care Continuum data in
aggregate and by subpopulation are also presented to the Workgroup, to providers, and the community
at large.
88
Surveillance and Program Data Monitored for Care Continuum
Stage of Care Continuum
Undiagnosed
Late Diagnosis
Linkage to HIV Medical Care
HIV Medical Visit Frequency
Prescription of ART
HIV Viral Load Suppression
2014 – 2015 Outcome
7.0%
26.6%
78.1%
65.0%
90.1%
80.2%
PDPH’s Surveillance Unit also collaborates with the Information Services Unit to create maps that
overlay HIV prevalence and recent diagnoses with prevention service sites and testing data. These maps
are used to redirect programs to target underserved geographic areas and for assessment and planning
purposes. Additionally, the two units collaborate to match HIV testing data submitted by PDPH-funded
providers. The match is conducted quarterly in order to determine newly-identified positives,
previously-identified positives, linkage to care among all positives, and linkage to care among all
positives within one month of an HIV test. The match includes confirmed positives and preliminary
positives. This information is reviewed by PDPH management and at Continuum Workgroup meetings. In
addition to collaboration with evaluation activities, PDPH uses surveillance data for various data-to-care
efforts.
START Care
PDPH provides technical support to Ryan White Program-funded clinics to identify persons living with
HIV/AIDS who have been out of clinical care. Staff from each participating clinic generate a list of all
patients meeting these criteria and securely transfers the list to PDPH. Upon receipt, PDPH crossmatches it with the Enhanced HIV Reporting System (eHARS) and other databases, which identifies
patients that have transferred care to other providers, migrated out of the city, are incarcerated, or are
deceased. Finally, PDPH returns the revised and updated case list to the clinic, which then uses the
revised list to conduct protocol-driven, clinic-led outreach to persons who are out of care with the goal
of reengaging the patient in HIV care. If errors in classification are identified by the Ryan White facility,
feedback is provided to the HIV surveillance staff so that errors can be resolved within eHARS. As part of
its START Care initiative, a stakeholder group with participation from the recipient and funded providers
has developed best practice protocols around routine screening, linkage to care, and the reengagement
of patients with gaps in medical visits.
CoRECT
The Cooperative Agreement Re-Engagement Controlled Trial (CoRECT) project is a 5-year CDC-funded
study initiated in 2014 in three U.S. jurisdictions, and will evaluate an intervention to identify HIVinfected persons who are out-of-care and engage them in HIV care. In Philadelphia, CoRECT builds on
the re-engagement standards established by the START Care stakeholder group. Patients who have been
determined to be out-of-care for at least six months at eight HIV care provider locations are randomized
89
to receive either field follow up by a disease intervention specialist (DIS) or outreach through the
program’s routine re-engagement protocols to assess the impact of a DIS-based model on patient
reengagement.
PDPH generates an out-of-care list using HIV laboratory surveillance data; collaborating medical facilities
will concurrently generate out-of-care lists using appointment data. The combined out-of-care list is
reconciled by the PDPH and medical facilities, and discussed at monthly case conferences. All individuals
determined to be out of care are randomized to receive either: usual linkage and engagement in
standard of care (SOC) or an active PDPH DIS intervention in addition to SOC. Individuals randomized to
the intervention arm receive DIS to locate, contact, and provide assistance to access HIV medical care.
Services provided as part of the intervention may include assistance with expedited medical
appointments, transportation, and access to community resources such as medical case management.
The Philadelphia CoRECT site aims to enroll 600 out-of-care HIV-infected individuals during a 2-year
enrollment period. Outcomes related to reengagement, retention, viral suppression and durable viral
suppression will be compared between out-of-care HIV-infected individuals receiving the study
intervention to those receiving SOC. Overall, CoRECT will demonstrate the feasibility of a joint health
department-medical facility intervention to identify recently out-of-care individuals and the
effectiveness of an active health department intervention to (re-)engage these individuals in HIV
medical care.
Disposition data from case conferences and through DIS outreach are used to regularly update eHARS
including current address, vital status, and current gender.
Data Sharing with Hepatitis and STD Programs
Sharing information between HIV and STD surveillance/Partner Services programs is important for
comprehensive disease intervention and offers many potential mutual benefits including updating
demographic and risk information and ensuring timely reporting and linkage to care. AACO continues to
provide line listings of newly diagnosed HIV cases to the STD program on a weekly basis to initiate HIV
Partner Services. In addition, the PDPH STD Control program submits lists of newly diagnosed syphilis
and gonorrhea cases to the HIV surveillance program for matching. All newly diagnosed syphilis and
gonorrhea cases that are co-infected with HIV are prioritized for Partner Services. Linkage and/or
engagement in care information including date, facility and value of the last viral load is provided to the
Partner Services program. This allows the Partner Services’ Disease Intervention Specialists (DIS) to
provide linkage and re-engagement services to those in need of these services.
Given the increasing incidence of injection drug use (IDU) among young people in Philadelphia,
collaboration between AACO and the viral Hepatitis Program (HEP) within the PDPH is of high priority.
The recent surge in injection drug use has resulted in a rise in hepatitis C virus (HCV) mono-infection, as
well as HCV-HIV co-infection. HIV data is matched to Hepatitis data monthly and enables the HEP to
prioritize co-infected patients for investigation. Because viral hepatitis infections are often exacerbated
in the presence of HIV, identifying co-infected patients ensures that these particularly high-risk
populations receive the hepatitis care they need. Hepatitis Investigators also ensure linkage to care for
90
newly diagnosed HIV cases, recommend that patients who have not had a recent HIV viral load return to
their providers for testing, and alert AACO staff of any new HBV or HCV diagnoses within its patient
population. Matches also allow for updating of demographic and risk information in both surveillance
systems.
Molecular HIV Surveillance
Understanding the transmission dynamics of the HIV epidemic is critical to effective intervention.
Several types of analyses are used to track HIV transmission in Philadelphia. Used independently, each
strategy captures a component of transmission dynamics, but has important limitations based on the
veracity, timeliness, and completeness of the data inputted. PDPH, in collaboration with the University
of Pennsylvania Center for AIDS Research (CFAR), is funded to conduct an integrated analysis of HIV
transmission networks in Philadelphia using multiple overlapping sources of data and analysis strategies.
PDPH/CFAR will construct a layered series of network analyses that link: i) phylogenetic data derived
from viral sequences obtained through clinical resistance testing, ii) individuals reported as partners
identified through contact tracing, and iii) reported social networks, including venues and social media
sites where sexual contacts are initiated. The layered HIV network analysis that is constructed will be
able to predict and trend changes in the transmission dynamics within Philadelphia at individual and
social levels, in real time, through a PDPH accessible web-based platform. The PDPH will then evaluate
the potential of the near real-time network analyses to enhance the piloting of interventions prioritizing
HIV testing, enhanced Partner Services, and treatment as prevention methodologies with the goal of
disrupting transmission in identified clusters.
FIMR-HIV
The goal of the Fetal Infant Mortality Review for HIV Prevention (FIMR-HIV) is to improve perinatal HIV
prevention systems by using the FIMR case review and community action process. FIMR-HIV is based on
the premise that the pregnancy experiences of women with HIV infection are sentinel events that
warrant review to inform interventions that will improve systems of care for the mother and infant. By
collecting comprehensive quantitative and qualitative data via medical record abstraction and maternal
interview, the methodology provides an in-depth look at the systems that result in a perinatal HIV
exposure or transmission. This examination allows communities to identify system strengths, missed
opportunities for prevention and, more rarely, failures of interventions to prevent perinatal
transmission. Communities can then develop and implement improvements to the systems of care for
women with HIV infection and their infants.
The EMA’s plan for monitoring and improvement focuses on the coordination and use of client-level
program and surveillance data along with other innovative efforts to achieve the objectives of the
National HIV/AIDS Strategy (NHAS). The EMA’s Data-to-Care strategy has resulted in directing resources
to aggressive interventions at critical points along the HIV Continuum of Care. Outcomes are regularly
disseminated to stakeholders and used for administration and planning. PDPH monitors trends in the
HIV Care Continuum and utilizes data for targeted improvement projects. These initiatives are closely
monitored by the recipient, PDPH’s Continuum Workgroup, OHP and the RWPC to measure the EMA’s
progress in achieving the goals outlined in the integrated plan.
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Appendices:
A: List of Public and Private Provider Agencies and
Workforce Capacity
B: Signed Letters of Concurrence
C: Glossary
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93
Appendix A: List of Public and Privately Funded Provider
Agencies and Workforce Capacity Tables
Non-Exhaustive List of Public and Privately Funded Provider Agencies
A list of providers by service for both publically and privately funded sites is displayed below. This is a
non-exhaustive compilation with the name of the organization/agency and its website. More detailed
information about provider services is available at the AIDS Library of Philadelphia FIGHT,
http://www.aidslibrary.org/our-publications/resource-guide-publications/ and through the Choice
Information Hotline, http://www.choice-philadelphia.org/. All providers with services contracted
through the AIDS Activities Coordinating Office are in bold and italics. The organization’s phone number
is provided is a website is not available.
Ambulatory Care
11th Street Family Health Services of Drexel University
Abbottsford-Falls Family Practice
AIDS Care Group- Edgmont Ave
AIDS Care Group-Sharon Hill
Albert Einstein Medical Center
Albert Einstein Medical Center Immunodeficiency
Center
Aria Health Hospital (formerly Frankford Hospital)
Asociacion Puertorriquenos en Marcha - Community
Health Clinic
Bergen Lanning Health Center
Brandywine Valley Infectious Diseases
Broad Street Health Center (Spectrum Health Services)
Bryn Mawr Family Practice
Bryn Mawr Hospital (Jefferson Health Care)
Burlington County Health Dept. @ Raphael Meadow
Cam Care Pediatrics
ChesPenn Health Services
Children's Hospital Of Philadelphia - Cobbs Creek
Children's Hospital Of Philadelphia - Special
Immunology Family Care Center
Children's Hospital Of Philadelphia Adolescent Clinic
Coatesville VA Medical Center
Congreso De Latinos Unidos, Inc.
Cooper At BMA/Willingboro
Cooper University Hospital Regional Family HIV
Treatment Center
Crozer-Chester Medical Center
Delaware Co. Memorial Hospital
www.drexel.edu/11thStreet
www.fpcn.com
www.aidscaregroup.org
www.aidscaregroup.org
www.einstein.edu
www.einstein.edu
www.ariahealth.org
www.apmphila.org
(856) 757-1770
(610) 383-9333
www.spectrumhs.org
www.mainlinehealth.org
www.mainlinehealth.org
www.co.burlington.nj.us/290/Health-Department
www.camcare.net/pediatric
www.chespenn.com
www.chop.edu
www.chop.edu
www.chop.edu/centers-programs/adolescentinitiative
www.coatesville.va.gov
www.congreso.net
www.cooperhealth.org
www.cooperhealth.org
www.crozer.org
www.crozer.org
94
Einstein Medical Center Montgomery
Einstein Medical Center: Immunodeficiency Clinic
Episcopal Hospital
Esperanza Health Center – Hunting Park Clinic
Esperanza Health Center – 5th street Clinic
Esperanza Health Center – Kensington Clinic
Fairmount Primary Care Center
Family Practice & Counseling Network Health Annex
Girard Medical Center
GPHA-4th Street Medical Suite
GPHA-Hunting Park Health Center
GPHA-South Philadelphia Health Center
GPHA-Southeast Health Center
GPHA-Wilson Park Medical Center
www.einstein.edu
www.einstein.edu
http://episcopal.templehealth.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.dvch.org
www.fpcn.com
www.nphs.com/girard_home.html
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
GPHA-Woodland Ave
Haddington Health Center - Spectrum Health Services
Hospital of the UPENN/ MacGregor Infectious
Disease Clinic
J. Edwin Wood Clinic
www.gphainc.org
www.spectrumhs.org
www.pennmedicine.org
Jefferson University Hospital Methodist Division
John Bell Health Center
Jonathan Lax Treatment Center
Kennedy Health Systems-Garden State Infectious
Disease Associates, P.A.
Kennedy Memorial Hospital - Washington Township
Kensington Hospital
Kensington Hospital-Erie Clinic
Maria de los Santos Health Center
Mazzoni Center
Mazzoni Center Family and Community Medicine
Memorial Hospital of Salem County-Clinic
Mercy Fitzgerald Hospital - Friday Clinic
Mercy Hospital HIV Services
Norristown Regional Health Center
Our Lady of Lourdes Medical Center
Partnership Comprehensive Care Practice
PDPH Health Care Center #10
PDPH Health Care Center #2
PDPH Health Care Center #3
PDPH Health Care Center #4
95
www.pennmedicine.org/providers/practice/j-edwinwood-clinic
http://hospitals.jefferson.edu/find-alocation/locations/methodist-hospital/
www.fight.org
www.fight.org
www.kennedyhealth.org
www.kennedyhealth.org
215-426-8100
215-426-8100
http://dvch.org/locations/maria-de-los-santoshealth-center/
www.mazzonicenter.org
www.mazzonicenter.org
www.mhschealth.com
www.mercyhealth.org
www.mercyhealth.org/mercyphiladelphia
www.dvch.org
www.lourdesnet.org
www.drexelmedicine.org/patient-services/infectiousdiseases/services/hiv-care/
www.phila.gov/health/ambulatoryhealth/hc10.html
www.phila.gov/health/ambulatoryhealth/hc2.html
www.phila.gov/health/ambulatoryhealth/hc3.html
www.phila.gov/health/ambulatoryhealth/hc4.html
PDPH Health Care Center #5
PDPH Health Care Center #6
PDPH Health Care Center #9
Pediatric Infectious Disease Center @ Cooper
Penn Community Practice at Presbyterian
Philadelphia Department of Public Health
PHMC Care Clinic
Puentos de Salud Clinic
QCHC Meade Family Health Center
QCHC Vaux Family Health Center
QCHC-Cooke Family Health Center
Quality Community Health Care
South Jersey Family Medical Center
Spectrum Community Health Center - Broad St
Health Center
Spectrum Community Health Center - 5201 Haverford
Ave
St. Christopher’s Hospital for Children
Strawberry Mansion Health Center
Temple University Comprehensive HIV Program
Thomas Jefferson University
Infectious Diseases
Urban Solutions
Valley Forge Medical Center and Hospital
Veterans Affairs Medical Center - ID Clinic
www.phila.gov/health/ambulatoryhealth/hc5.html
www.phila.gov/health/ambulatoryhealth/hc6.html
www.phila.gov/health/ambulatoryhealth/hc9.html
www.cooperhealth.org/departmentsprograms/pediatric-infectious-diseases
www.pennmedicine.org/penn-presbyterian-medicalcenter/services-programs.html
www.phila.gov/health
www.phmc.org/site/programs/health-care-centers
http://puentesdesalud.org
www.qchc.org/AboutUs.htm
www.qchc.org/AboutUs.htm
www.qchc.org/AboutUs.htm
www.qchc.org/index.htm
www.sjfmc.org/
www.spectrumhs.org
www.spectrumhs.org
www.scfchildren.org/dorothy-mann-center-forpediatric-and-adolescent-hiv-2
www.phila.gov/health/ambulatoryhealth/hcStrawbe
rry.html
www.temple.edu/medicine/departments_centers/cli
nical_departments/medicine_gim_hiv.htm
http://hospitals.jefferson.edu/departments-andservices/infectious-diseases/
http://myuhi.org/
www.vfmc.net/index.html
www.philadelphia.va.gov/
Case Management
ACLAMO Family Centers of Montgomery County
ACT One (Achievement Through Counseling and
Treatment)
ACT Two (Achievement Through Counseling and
Treatment)
Action Wellness- 1026 Arch Street
Action Wellness- Delaware County Office
Action Wellness-West
African Family Health Organization (AFAHO)
AIDS Care Group
AIDS Community Care Alternatives Program (ACCAP)
www.aclamo.org
www.jevshumanservices.org
www.jevshumanservices.org
www.actionwellness.org
www.actionwellness.org
www.actionwellness.org
www.afaho.net/
www.aidscaregroup.org
www.state.nj.us/humanservices/dds/ohcs/waiver/acc
ap/
96
Asociacion de Puertorriquenos en Marcha- Main
Office
Attic Youth Center
BEBASHI
Bergen Lanning Health Center
Black Women's Health Alliance
Burlington County Health Dept. @ Raphael Meadow
Camden County Division of Health - Special Child
Health Services
Children's Hospital Of Philadelphia - Cobbs Creek
Children's Hospital Of Philadelphia - Special
Immunology Family Care Center
Children's Hospital Of Philadelphia Adolescent Clinic
Congreso De Latinos Unidos, Inc.
Cooper EIP
Cooper University Hospital Regional Family HIV
Treatment Center
Covenant House Health Services
Delaware Co. Office of Behavioral Health
Delaware County Department of Health
Easton Area Neighborhood Centers, Inc
Episcopal Hospital
Esperanza Health Center – Hunting Park Clinic
Esperanza Health Center – 5th street Clinic
Esperanza Health Center – Kensington Clinic
Family and Community Service of Delaware County
Family Practice & Counseling Network Health Annex
Family Service Association of Bucks County
Family Service of Chester County
Family Services of Montgomery County
Gay & Lesbian Latino AIDS Education Initiative
(GALAEI) Project
Good Shepard Program of St. Johns Hospice
GPHA-4th Street Medical Suite
GPHA-Hunting Park Health Center
GPHA-Southeast Health Center
GPHA-Wilson Park Medical Center
GPHA-Woodland Ave
Haddington Health Center - Spectrum Health Services
Healthstart - Memorial Hospital Of Salem County
Holcomb Behavioral Health Systems
Hospital of the UPENN/ MacGregor Infectious Disease
Clinic
97
www.apmphila.org
www.atticyouthcenter.org
www.bebashi.org
(856) 757-1770
www.pbwha.org
www.co.burlington.nj.us/290/Health-Department
www.state.nj.us/health/fhs/sch/index.shtml
www.chop.edu
www.chop.edu
www.chop.edu/centers-programs/adolescentinitiative
www.congreso.net
www.cooperhealth.org
www.cooperhealth.org
www.covenanthousepa.org
www.delcohsa.org/behavioralhealth.html
www.co.delaware.pa.us/intercommunity
www.eastonareaneighborhoodcenter.org
http://episcopal.templehealth.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.fcsdc.org
www.fpcn.com
www.fsabc.org
www.familyservice.us
www.fsmontco.org
www.galaei.org
http://saintjohnshospice.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.spectrumhs.org
www.mhschealth.com
www.chimes.org/holcomb/
www.pennmedicine.org
Jonathan Lax Treatment Center
Kennedy Health Systems-Garden State Infectious
Disease Associates, P.A.
Kennedy Health Systems-Raphael Meadow Center
Kensington Hospital
Maria de los Santos Health Center
Mazzoni Center
ODAAT, North
Partnership Comprehensive Care Practice
PDPH Health Center 10
PDPH Health Center 2
PDPH Health Center 3
PDPH Health Center 4
PDPH Health Center 5
PDPH Health Center 6
PDPH Health Center 7
Philadelphia FIGHT
PHMC Care Clinic
Prevention Point Philadelphia
Project H.O.M.E.
Puerto Rican Action Committee
Puerto Rican Unity for Progress
Quality Community Health Care
Salem County Social Services
St. Christopher’s Hospital for Children
St. John's Hospice
Strawberry Mansion Health Center
Temple University Comprehensive HIV Program
The Attic Youth Center
Urban Solutions
Valley Forge Medical Center and Hospital
Veterans Affairs Medical Center –ID clinic
Veterans Affairs Medical Center –ID Clinic
Women's Care Center
Women's Institute for Family Health
www.fight.org
http://www.kennedyhealth.org
www.kennedyhealth.org
215-426-8100
http://dvch.org/locations/maria-de-los-santos-healthcenter/
www.mazzonicenter.org
www.uac.org/partners/one-day-time-odaat
www.drexelmedicine.org/patient-services/infectiousdiseases/services/hiv-care/
www.phila.gov/health/ambulatoryhealth/hc10.html
www.phila.gov/health/ambulatoryhealth/hc2.html
www.phila.gov/health/ambulatoryhealth/hc3.html
www.phila.gov/health/ambulatoryhealth/hc4.html
www.phila.gov/health/ambulatoryhealth/hc5.html
www.phila.gov/health/ambulatoryhealth/hc6.html
www.phila.gov/health/ambulatoryhealth/hc9.html
www.fight.org
www.phmc.org/site/programs/health-care-centers
www.ppponline.org
www.projecthome.org
www.pracnj.com
www.prupnj.org
www.qchc.org
http://health.salemcountynj.gov
www.scfchildren.org/dorothy-mann-center-forpediatric-and-adolescent-hiv-2
http://saintjohnshospice.org
www.phila.gov/health/ambulatoryhealth/hcStrawberr
y.html
www.temple.edu/medicine/departments_centers/cli
nical_departments/medicine_gim_hiv.htm
www.atticyouthcenter.org/
www.myuhi.org/
www.vfmc.net/index.html
www.philadelphia.va.gov
www.philadelphia.va.gov
www.cooperhealth.org/departments-programs/ripacenter-womens-health-wellness
www.wifamilyhealth.org/
98
Condom Distribution
Crozier Keystone Health Systems
Delaware Valley Community Health
www.crozer.org
www.dvch.org
Esperanza Health Center – Hunting Park Clinic
Esperanza Health Center – 5th street Clinic
Esperanza Health Center – Kensington Clinic
GALAEI
PDPH Health Center #1
Quality Community Health Care - Cooke Family
Health Center
Quality Community Health Care - Meade Family
Health Center
Quality Community Health Care- 2501 Lehigh Ave
Spectrum Community Health Center - Broad St
Health Center
Spectrum Community Health Center - 5201 Haverford
Ave
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.galaei.org
www.phila.gov/health/ambulatoryhealth/hc1.html
www.qchc.org
www.qchc.org
www.qchc.org
www.spectrumhs.org
www.spectrumhs.org
Dental Care
11th Street Family Health Services of Drexel University
Abbottsford-Falls Family Practice
AIDS Care Group
ChesPenn Health Services
Delaware Valley Community Health Inc.- Fairmount
Health Center
Esperanza Health Center - Kensington Clinic
Fairmount Primary Care Center
Family Practice & Counseling Network Health Annex
Family Service Association of Bucks County
GPHA-Dental and Behavorial Healthcare
GPHA-Hunting Park Health Center
GPHA-Snyder Avenue Dental Center
GPHA-Southeast Health Center
GPHA-Wilson Park Medical Center
Maria de los Santos Health Center
PDPH Health Center 10
PDPH Health Center 2
PDPH Health Center 3
PDPH Health Center 4
PDPH Health Center 5
PDPH Health Center 6
PDPH Health Center 7
99
www.drexel.edu/11thStreet
www.fpcn.com
www.aidscaregroup.org
www.chespenn.com
www.dvch.org
www.esperanzahealthcenter.org
www.dvch.org
www.fpcn.com
www.fsabc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
http://dvch.org/locations/maria-de-los-santoshealth-center/
www.phila.gov/health/ambulatoryhealth/hc10.html
www.phila.gov/health/ambulatoryhealth/hc2.html
www.phila.gov/health/ambulatoryhealth/hc3.html
www.phila.gov/health/ambulatoryhealth/hc4.html
www.phila.gov/health/ambulatoryhealth/hc5.html
www.phila.gov/health/ambulatoryhealth/hc6.html
www.phila.gov/health/ambulatoryhealth/hc9.html
Quality Community Health Care
South Jersey Family Medical Center
Strawberry Mansion Health Center
Temple University Kornberg School of Denistry
University Dental Center At Somerdale
University of Pennsylvania School of Dentistry
www.qchc.org/index.htm
www.sjfmc.org/
www.phila.gov/health/ambulatoryhealth/hcStrawberr
y.html
www.dentistry.temple.edu/
www.sdm.rutgers.edu/about/admin_extramural.ht
m
www.pennmedicine.org
Direct Emergency Financial Assistance
Public Health Management Corporation
Utility Emergency Services Fund
www.phmc.org
www.uesfacts.org
Faith-based
Arch Street United Methodist Church
Bright Hope Baptist Church
Broad Street Ministry
Calvary United Methodist Church
Church of the Advocate
Enon Tabernacle Baptist Church
First United Methodist Church of Germantown
Germantown Mennonite Church
Saint Luke’s Church
Saint Mary of Grace Parish
Saint Michael’s Lutheran Church
www.archstreetumc.org
www.brighthopebaptist.org
www.broadstreetministry.org
www.allmeansall.org
www.churchoftheadvocate.org
www.enontab.org
www.fumcog.org/
www.germantownmennonite.org
www.stlukeandtheepiphany.org
www.inclusivecatholics.org
www.stmichaelsgermantown.org/
Food Bank, Home Delivered and Congregate Meals
AIDS Care Group
Apostles' Lutheran Church, Caring Circle Program
BEBASHI
Broad Street Health Center (Spectrum Health Services)
Catholic Charities
Congreso De Latinos Unidos, Inc.
Covenant House Health Services
Easton Area Neighborhood Centers, Inc.
Food Resource Guide
Food Stamp Hotline/ Greater Philadelphia Coalition
Against Hunger
Food Stamp Hotline/ Greater Philadelphia Coalition
Against Hunger
Gloucester County Division of Social Services
www.aidscaregroup.org
www.gloucestercountynj.gov/depts/s/boardss/emerfp
.asp
www.bebashi.org
www.spectrumhs.org/
www.catholiccharitiescamden.org/basicneeds/
www.congreso.net/
www.covenanthousepa.org
www.eastonareaneighborhoodcenter.org
www.pcacares.org/foodresources
www.hungercoalition.org
www.hungercoalition.org
www.gloucestercountynj.gov/depts/s/boardss/default
.asp
100
Jewish Family and Children's Services
MANNA- Metropolitan Area Neighborhood Nutrition
Alliance
Mazzoni Center
Meals on Wheels of Salem County, Inc.
ODAAT, North
Public Health Management Corp. – Food Vouchers
Puerto Rican Action Committee
Salem County Board of Social Services
Spirit Life Fellowship/Oasis Kitchen
St. Andrew The Apostle RC Church
St. John's Hospice
St. Vincent DePaul
Volunteers of America Homeless Prevention
Women's Institute for Family Health
https://www.jfcsphilly.org/main-home-page/childrenteens-families/financial-assistance/
www.mannapa.org/
www.mazzonicenter.org
www.scmealsonwheels.org/services/
www.uac.org/partners/one-day-time-odaat
www.Phmc.org
www.pracnj.com/pracservices.html
www.scbssnj.org
www.spiritlifefellowship.net/oasis-kitchen.php
www.churchofsaintandrews.org
www.saintjohnshospice.org
hwww.vincentdepaul.org
www.voadv.org
www.wifamilyhealth.org
General Information, Prevention Education & Referral Services
Access Matters
Aclamo Family Centers
Action AIDS- 1026 Arch Street
AIDS Activities Coordinating Office
AIDS Law Project in Pennsylvania
AIDS Library
AIDS Treatment News
American Red Cross of Southeastern PA Chapter
Aspira, Inc. of Pennsylvania
Attic Youth Center
BEBASHI
Bucks County Health Department: Doylestown
Bucks County Health Department: Levittown
Burlington County Board Of Social Services
Burlington County Community Action Program
Camden Area Health Education Center (AHEC)
CATA - El Comite de Apoyo a Los
Catholic Charities - Family & Community Center
Catholic Social Services- Philadelphia
Center for Family Services- Family Support CenterGloucester
Chester County Health Department
Children's Hospital Of Philadelphia - Special
Immunology Family Care Center
Children's Hospital Of Philadelphia Adolescent Clinic
101
www.accessmatters.org
www.aclamo.org/
www.actionaids.org
www.phila.gov/health/aaco/index.html
www.aidslawpa.org
www.aidslibrary.org
www.aidsnews.org
www.redcross.org/pa/philadelphia
www.aspirapennsylvania.org/
www.atticyouthcenter.org
www.bebashi.org
www.buckscounty.org
www.buckscounty.org
www.bcbss.org/
www.bccap.org/
www.camden-ahec.org
www.cata-farmworkers.org/
www.catholiccharitiescamden.org/
www.css-phl.org
www.centerffs.org/
www.chesco.org/health
www.chop.edu
www.chop.edu/centers-programs/adolescentinitiative
CHOICE
Coatesville VA Medical Center
COLOURS
Community Health and Education Outreach (CHEO)
Contact of Burlington County
Crossroads Programs
Delaware County Department of Health
Easton Area Neighborhood Centers, Inc
Fam Care, Inc.
Family Service of Chester County
Family Services of Montgomery County
Gay & Lesbian Latino AIDS Education Initiative
(GALAEI) Project
Gloucester County Division of Social Services
Hispanic Family Center of Southern NJ, Inc.
HIV/AIDS Fact line -CHOICE
Jewish Family and Children's Services
Jewish Family and Children's Services
Mazzoni Center
Philadelphia FIGHT
Planned Parenthood of Chester County
Prevention Plus of Burlington County
Puerto Rican Action Committee
Puerto Rican Unity for Progress
Salem County Office for the Disabled
Salem County Social Services
St. Christopher’s Hospital for Children
Women's Care Center
Youth Outreach Adolescent Community Awareness
Program (YOACAP)
www.choice-phila.org
www.coatesville.va.gov
www.coloursorganization.org
www.cheoinc.com
www.contactburlco.org
www.crossroadsprograms.org/about_crossroads/ourprograms.html
www.co.delaware.pa.us/intercommunity
www.eastonareaneighborhoodcenter.org/Services.ht
ml
www.famcare8.wwwssr10.supercp.com/services/
www.familyservice.us
www.fsmontco.org
www.galaei.org
www.gloucestercountynj.gov/depts/s/boardss/default
.asp
www.hispanicfamilycenter.com/
www.choice-phila.org
www.jfcsphilly.org/main-home-page/children-teensfamilies/financial-assistance/
www.jfcsphilly.org/main-home-page/children-teensfamilies/family-life-educational-programs-workshops/
www.mazzonicenter.org
www.fight.org
www.plannedparenthood.org/healthcenter/pennsylvania/west-chester/19382/westchester-health-center-3356-91460
www.prevplus.org
www.pracnj.com/pracservices.html
www.prupnj.org/charity-organization-contact-us
www.salemcountynj.gov/departments/office-ofdisability-services
http://health.salemcountynj.gov
www.scfchildren.org/dorothy-mann-center-forpediatric-and-adolescent-hiv-2
www.cooperhealth.org/departments-programs/ripacenter-womens-health-wellness
http://www.yoacap.org/
102
HIV Testing
11th Street Family Health Services of Drexel University
AACO Partner Services/Philadelphia Department of
Public Health (PDPH)
Abbottsford-Falls Family Practice
Access Matters
ActionAIDS
ActionAIDS- North – Casa Nueva
ActionAIDS- Washington West Project
African Family Health Organization (AFAHO)
AIDS Care Group - Sharon Hill
AIDS Care Group - Edgmont Ave
Albert Einstein Medical Center: Immunodeficiency
Center
Attic Youth Center
Broad St Health Center-Spectrum Community Health
Center
Bucks County Health Department: Doylestown
Bucks County Health Department: Levittown
Camden Area Health Education Center (AHEC)
ChesPenn Health Services-Center for Family Health
Children's Hospital Of Philadelphia Adolescent Clinic
COLOURS
Congreso De Latinos Unidos, Inc.- Programa Esfuerzo
Congreso De Latinos Unidos, Inc.-Somerset
Cooper University Hospital
Delaware County State Health Center
Esperanza Health Center – Hunting Park Clinic
Esperanza Health Center – 5th street Clinic
Esperanza Health Center – Kensington Clinic
Fairmount Primary Care Center
Fam Care, Inc.
Family Practice & Counseling Network Health Annex
Family Services of Montgomery County
Family Services of Montgomery County-Pottstown
office
Frankford Avenue Health Center
Gay & Lesbian Latino AIDS Education Initiative
(GALAEI) Project
GPHA- Chinatown Medical Services
GPHA-Hunting Park Health Center
GPHA-Southeast Health Center
103
www.drexel.edu/11thStreet
www.phila.gov/health/aaco/Prevention.html
www.fpcn.com
www.accessmatters.org
www.actionaids.org
www.actionaids.org
www.actionaids.org
www.afaho.net
www.aidscaregroup.org
www.aidscaregroup.org
www.einstein.edu
www.atticyouthcenter.org
www.spectrumhs.org/
www.buckscounty.org
www.buckscounty.org
www.camden-ahec.org
www.chespenn.com
www.chop.edu/centers-programs/adolescentinitiative
www.coloursorganization.org
www.congreso.net/
www.congreso.net/
www.cooperhealth.org
www.co.delaware.pa.us/intercommunity/pastatedel
cocenter.html
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.dvch.org
www.famcareinc.org
www.fpcn.com
www.fsmontco.org
www.fsmontco.org
www.gphainc.org
www.galaei.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
GPHA-Wilson Park Medical Center
GPHA-Woodland Ave
Kensington Hospital
Kensington Hospital- Erie Clinic
Neighborhood United Against Drugs (NUAD)
ODAAT
Partnership Comprehensive Care Practice
PDPH Health Care Center #10
PDPH Health Care Center #1
PDPH Health Care Center #2
PDPH Health Care Center #3
PDPH Health Care Center #4
PDPH Health Care Center #5
PDPH Health Care Center #6
PDPH Health Care Center #9
Penn Community Practice at Presbyterian
Philadelphia FIGHT
Planned Parenthood - Bensalem
Planned Parenthood - Bristol
Planned Parenthood - Castor Ave
Planned Parenthood - Chester County
Planned Parenthood - Coatesville
Planned Parenthood - Elizabeth Blackwell Center
Planned Parenthood - Locust St
Planned Parenthood - Media
www.gphainc.org
www.gphainc.org
215-426-8100
215-426-8100
www.uac.org/partners/neighborhood-unitedagainst-drugs-nuad
www.uac.org/partners/one-day-time-odaat
www.drexelmedicine.org/patient-services/infectiousdiseases/services/hiv-care/
www.phila.gov/health/ambulatoryhealth/hc10.html
www.phila.gov/health/ambulatoryhealth/hc1.html
www.phila.gov/health/ambulatoryhealth/hc2.html
www.phila.gov/health/ambulatoryhealth/hc3.html
www.phila.gov/health/ambulatoryhealth/hc4.html
www.phila.gov/health/ambulatoryhealth/hc5.html
www.phila.gov/health/ambulatoryhealth/hc6.html
www.phila.gov/health/ambulatoryhealth/hc9.html
www.pennmedicine.org/penn-presbyterian-medicalcenter/services-programs.html
www.fight.org
www.plannedparenthood.org/healthcenter/pennsylvania/bensalem/19020/bensalemmedical-center-2513-91410
www.plannedparenthood.org/healthcenter/pennsylvania/bristol/19007/bristol-medicalcenter-2511-91410/birth-control
www.plannedparenthood.org/healthcenter/pennsylvania/philadelphia/19152/castorave.-health-center-2512-91460
www.plannedparenthood.org/healthcenter/pennsylvania/west-chester/19382/westchester-health-center-3356-91460
www.plannedparenthood.org/healthcenter/pennsylvania/coatesville/19320/coatesvillehealth-center-2724-91460
www.plannedparenthood.org/healthcenter/pennsylvania/philadelphia/19107/elizabethblackwell-health-center-2516-91460
www.plannedparenthood.org/healthcenter/pennsylvania/philadelphia/19107/locuststreet-surgical-center-3360-91460
www.plannedparenthood.org/healthcenter/pennsylvania/media/19063/media-healthcenter-2338-91460
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Planned Parenthood - Norristown
Planned Parenthood - Pottstown
Planned Parenthood - Quakertown
Planned Parenthood - The Atrium
Planned Parenthood - Upper Darby
Planned Parenthood - West Chester
Prevention Point Philadelphia- Indiana Outreach Site
Prevention Point Philadelphia- North Central
Philadelphia Outreach Site
Prevention Point Philadelphia-Kensington Ave
Prevention Point Philadelphia-North Philadelphia
Outreach Site
Prevention Point Philadelphia-South Philadelphia
Outreach Site
Prevention Point Philadelphia-West Philadelphia
Outreach Site
QCHC Meade Family Health Center
QCHC Vaux Family Health Center
QCHC-Cooke Family Health Center
Quality Community Health Care-West Lehigh Ave
Spectrum Community Health Center-Haverford Ave
St. Christopher’s Hospital for Children
Strawberry Mansion Health Center
Temple University Comprehensive HIV Program
Urban Solutions
Youth Health Empowerment Project (YHEP)
Youth Outreach Adolescent Community Awareness
Program (YOACAP)
105
www.plannedparenthood.org/healthcenter/pennsylvania/norristown/19401/norristownhealth-center-3440-91460
www.plannedparenthood.org/healthcenter/pennsylvania/pottstown/19464/pottstownhealth-center-2340-91460
www.plannedparenthood.org/healthcenter/pennsylvania/quakertown/18951/quakertow
n-health-center-2515-91410
www.plannedparenthood.org/healthcenter/all/all/18974
www.plannedparenthood.org/healthcenter/pennsylvania/upper-darby/19082/upperdarby-health-center-4094-91460
www.plannedparenthood.org/healthcenter/pennsylvania/west-chester/19382/westchester-health-center-3356-91460
http://ppponline.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
www.qchc.org
www.qchc.org
www.qchc.org
www.qchc.org
www.spectrumhs.org
www.scfchildren.org/dorothy-mann-center-forpediatric-and-adolescent-hiv-2
www.phila.gov/health/ambulatoryhealth/hcStrawbe
rry.html
www.temple.edu/medicine/departments_centers/cli
nical_departments/medicine_gim_hiv.htm
http://myuhi.org
www.fight.org
www.yoacap.org
Home Health Care
Abington Health Association
Affilia Home Health
Coatesville VA Medical Center
Delaware County Memorial Hospital
Hahnemann University Hospital
Keystone Home Health and Hospice
www.npvna.org
www.affiliahomehealth.org
www.coatesville.va.gov
www.crozer.org
www.hahnemannhospital.com
www.keystonecare.com/hospice.aspx
Housing Assistance/Shelter
ACHIEVEability
ACLAMO Family Centers of Montgomery County
Action AIDS- 1216 Arch Street
ActionAIDS-North-Casa Nueva
AIDS Activities Coordinating Office
AIDS Care Group - Sharon Hill
AIDS Law Project in Pennsylvania
Asociacion de Puertorriquenos en Marcha- Main
Office
Asociacion de Puertorriquenos en Marcha-Housing
Asociacion Puertorriquenos en Marcha - Community
Health Clinic
BEBASHI
Bethesda Project
Bucks Villa
Burlington County Board Of Social Services
Burlington County Community Action Program
Calcutta House-Independence Place
Calcutta House-Serenity Court
Camden County Council on Economic Opportunity, Inc
Center for Family Services, Inc.
Coatesville VA Medical Center
COMHAR
Commission on Human Relations/Fair Housing
Commission
Congreso De Latinos Unidos, Inc.-Somerset
Crossroads Programs
Easton Area Neighborhood Centers, Inc.
Families Forward Philadelphia
Family and Community Service of Delaware County
Family Service Association of Bucks County
Family Services of Montgomery County
Frankford Avenue Health Center
Friends Rehabilitation Program
www.achieveability.org
www.aclamo.org
www.actionaids.org
www.actionaids.org
www.phila.gov/health/aaco/Housing.html
www.aidscaregroup.org
www.aidslawpa.org
www.apmphila.org
www.apmphila.org
www.apmphila.org
www.bebashi.org
www.bethesdaproject.org
www.bucksvilla.org
www.bcbss.org
www.bccap.org/
www.calcuttahouse.org
www.calcuttahouse.org
www.camdencountyoeo.com
www.centerffs.org
www.coatesville.va.gov
www.comhar.org/services/adult
www.phila.gov/humanrelations
www.congreso.net/
www.crossroadsprograms.org
www.eastonareaneighborhoodcenter.org
www.taphilly.org
www.fcsdc.org
www.fsabc.org
www.fsmontco.org
www.gphainc.org
www.friends-frp.com
106
Gay & Lesbian Latino AIDS Education Initiative
(GALAEI) Project
Gloucester County Division of Social Services
Good Shepherd Program
Homelessness Prevention Program
Interfaith Homeless Outreach Council
Mazzoni Center
Moorestown Ecumenical Neighborhood Development
(MEND)
Project H.O.M.E.
Puerto Rican Action Committee
Puerto Rican Unity for Progress
Ralph Moses House
Salem County Board of Social Services
St. John's Hospice
Utility Emergency Services Fund
www.galaei.org
www.gloucestercountynj.gov/depts/s/boardss/default
.asp
www.saintjohnshospice.org
www.state.nj.us/dca/divisions/dhcr/offices/hpp.html
www.ihocsj.org
www.mazzonicenter.org
www.mendinc.org
https://projecthome.org/
www.pracnj.com/pracservices.html
www.prupnj.org/charity-organization-contact-us
www.fcsdc.org
www.scbssnj.org
www.saintjohnshospice.org
www.uesfacts.org
Legal Services
AIDS Law Project of Pennsylvania
AIDS Law Project of Southern New Jersey
American Civil Liberties Union (ACLU) of Pennsylvania
Burlington County Bar Foundation - Lawyers Referral
Community Legal Services
Covenant House Health Services
Department of Law and Public Safety, Division of Civil
Rights
Gloucester County Bar Foundation
Legal Assistance of Southeastern PA
Mazzoni Center
Puerto Rican Action Committee
South Jersey Legal Services
www.aidslawpa.org
www.aidslawnj.org
www.aclupa.org
http://burlcobar.org/bar-foundation
www.clsphila.org
www.covenanthousepa.org
www.nj.gov/oag/dcr/index.html
http://www.gcbarfoundation.org
http://lasp.org
www.mazzonicenter.org
http://www.pracnj.com/pracservices.html
http://www.lsnj.org/sjls
Medications and on Site Pharmacy
AIDS Drug Distribution Program of New Jersey
(ADDP)
Albert Einstein Medical Center Immunodeficiency
Center
Children's Hospital Of Philadelphia - Special
Immunology Family Care Center
Children's Hospital Of Philadelphia Adolescent Clinic
Community A Walgreens Pharmacy
107
www.nj.gov/health/aids/freemeds.shtml
www.einstein.edu
www.chop.edu
www.chop.edu/centers-programs/adolescentinitiative
www.walgreens.com
Community Health and Education Outreach (CHEO)
Esperanza Health Center – Hunting Park Site
Esperanza Health Center – 5th street Site
Esperanza Health Center – Kensington Site
Family Practice & Counseling Network Health Annex
GPHA-4th Street Medical Suite
GPHA-Hunting Park Health Center
GPHA-Wilson Park Medical Center
GPHA-Woodland Ave
Hospital of the UPENN/ MacGregor Infectious Disease
Clinic
Lax Center
PDPH Health Care Center #10
PDPH Health Care Center #2
PDPH Health Care Center #3
PDPH Health Care Center #4
PDPH Health Care Center #5
PDPH Health Care Center #6
PDPH Health Care Center #9
Special Pharmaceutical Benefits Program –
Pennsylvania ADAP
Strawberry Mansion Health Center
Valley Forge Medical Center and Hospital
Veterans Affairs Medical Center
Walgreen's - 1101 Locust St
Walgreen's - 1227 Locust St
Walgreen's - 807 Locust St
www.cheoinc.com
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.fpcn.com
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.gphainc.org
www.pennmedicine.org
www.fight.org
www.phila.gov/health/ambulatoryhealth/hc10.html
www.phila.gov/health/ambulatoryhealth/hc2.html
www.phila.gov/health/ambulatoryhealth/hc3.html
www.phila.gov/health/ambulatoryhealth/hc4.html
www.phila.gov/health/ambulatoryhealth/hc5.html
www.phila.gov/health/ambulatoryhealth/hc6.html
www.phila.gov/health/ambulatoryhealth/hc9.html
www.dhs.pa.gov/provider/healthcaremedicalassistanc
e/specialpharmaceuticalbenefitsprogram/
www.phila.gov/health/ambulatoryhealth/hcStrawbe
rry.html
www.vfmc.net/index.html
www.philadelphia.va.gov
www.walgreens.com
www.walgreens.com
www.walgreens.com
Mental and Behavioral Health Services
11th Street Family Health Services of Drexel University
Abbottsford-Falls Family Practice
Action AIDS- 1216 Arch Street
AIDS Care Group
Albert Einstein Medical Center Immunodeficiency
Center
Asociacion Puertorriquenos en Marcha
Belmont Center for Comprehensive Treatment
Bethanna
Black Women's Health Alliance
Bridge Treatment Program
Burlington Comprehensive Counseling Inc.
Center for Family Services, Inc-
www.drexel.edu/11thStreet
www.fpcn.com
www.actionaids.org
www.aidscaregroup.org
www.einstein.edu
www.apmphila.org
www.einstein.edu/locations/belmont-behavioralhealth/
www.bethanna.org/bethanna
www.pbwha.org
www.thebridgePhiladelphia.org
http://burlingtoncomprehensive.com
www.centerffs.org
108
Children's Hospital Of Philadelphia - Special
Immunology Family Care Center/
Coatesville VA Medical Center
COMHAR
COMHAR - Community Living Room
COMHAR – PACT
Community Behavioral Health (CBH)
Community Council for Health
Consortium
Cooper EIP
Crisis Response Center at Einstein-Germantown
Community Center
Crisis Response Center at Friends Hospital
Crisis Response Center at Hall Mercer/ Pennsylvania
Hospital
Crisis Response Center at Temple/ Episcopal Hospital
Delaware Co. Office of Behavioral Health
Department of Behavioral Health and Intellectual
DisAbility Services
Drenk Behavioral Health Center
Episcopal Hospital
Esperanza Health Center
Esperanza Health Center – Hunting Park Site
Esperanza Health Center – 5th street Site
Esperanza Health Center – Kensington Site
Family and Community Service of Delaware County
Family Practice & Counseling Network Health Annex
Family Service Association of Bucks County
Family Service of Chester County
Family Services of Montgomery County
Gaudenzia Inc.
Gaudenzia, Inc.
GPHA-4th Street Medical Suite
GPHA-Frankford Ave Behavioral Health Center
Healthcare Commons, Inc.
Hispanic Family Center of Southern NJ, Inc.
Holcomb Behavioral Health Systems
Horizon House
Horizon House
Human Services, Inc.
Jonathan Lax Treatment Center
Kennedy Health Systems-Garden State Infectious
Disease Associates, P.A.
Kennedy University Hospitals, Inc. - Behavioral Health
109
www.chop.edu
www.coatesville.va.gov
www.comhar.org/services/adult
www.comhar.org/services/adult
www.comhar.org/services/adult
www.phila.gov/dbhids
www.cchss.org
www.consortium-inc.org
www.cooperhealth.org
www.eistein.edu
www.friendshospital.com
www.mercyhealth.org/mercyPhiladelphia
www.episcopal.templehealth.org
www.delcohsa.org/behavioralhealth.html
www.dbhids.org
http://www.drenk.org/
http://episcopal.templehealth.org/
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.fcsdc.org
www.fpcn.com
www.fsabc.org
www.familyservice.us
www.fsmontco.org
http://www.gaudenzia.org.
http://www.gaudenzia.org
www.gphainc.org
www.gphainc.org
www.hcommons.com
www.hispanicfamilycenter.com
www.chimes.org/holcomb
www.hhinc.org
www.hhinc.org
www.hsi-cmhs.com
www.fight.org
www.kennedyhealth.org
www.kennedyhealth.org
Kensington Hospital
Kirkbride Rehabilitation Center
Maryville, Inc.
Mazzoni Center
Northeast Treatment Center
Partnership Comprehensive Care Practice
PDPH Health Care Center #3
PDPH Health Care Center #4
Philadelphia Mental Health Care Corporation
St. Christopher’s Hospital for Children
Strawberry Mansion Health Center
215-426-8100
www.kirkbridecenter.org
http://maryvillenj.org
www.mazzonicenter.org
http://netcenters.org
www.drexelmedicine.org/patient-services/infectiousdiseases/our-locations/
www.phila.gov/health/ambulatoryhealth/hc3.html
www.phila.gov/health/ambulatoryhealth/hc4.html
http://pmhcc.org
www.scfchildren.org/dorothy-mann-center-forpediatric-and-adolescent-hiv-2
www.phila.gov/health/ambulatoryhealth/hcStrawbe
rry.html
Nutrition Services and Assessment
11th Street Family Health Services of Drexel University
AIDS Care Group
Children's Hospital Of Philadelphia - Special
Immunology Family Care Center
Community Health and Education Outreach (CHEO)
Esperanza Health Center – Hunting Park Clinic
Esperanza Health Center – 5th street Clinic
Esperanza Health Center – Kensington Clinic
MANNA- Metropolitan Area Neighborhood Nutrition
Alliance
Partnership Comprehensive Care Practice
PHMC Care Clinic
Temple University Comprehensive HIV Program
www.drexel.edu/11thStreet
www.aidscaregroup.org
www.chop.edu
www.cheoinc.com
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.esperanzahealthcenter.org
www.mannapa.org/
www.drexelmedicine.org/patient-services/infectiousdiseases/our-locations/
www.phmc.org/site/programs/health-care-centers
www.temple.edu/medicine/departments_centers/cli
nical_departments/medicine_gim_hiv.htm
Pre Exposure Prophylaxis (PrEP) Providers
AIDS Care Group- Edgemont Ave
AIDS Care Group-Sharon Hill
Albert Einstein Medical Center
*If patient of Einstein Hospital*
Brandywine Valley Infectious
Disease Associates
Children’s Hospital of Philadelphia
Adolescent Initiative
Congreso De Latinos Unidos, Inc.
www.aidscaregroup.org
Robert A Fischer, MD
www.aidscaregroup.org
www.einstein.edu
Raida Rabah, MD
(610) 383-9333
Steven D. Douglas, MD
www.chop.edu/centersprograms/adolescent-initiative
www.congreso.net/
110
Dorothy Mann Center for Pediatric
and Adolescent HIV at
St. Christopher’s Hospital for
Children
Drexel University
College of Medicine/Partnership
Comprehensive Care Practice 1
Family Practice & Counseling
Network Health Annex
Family Practice & Counseling
Network-Abbottsford Falls
Garden State Infectious Diseases
Associates, P.A
(Kennedy Health Systems)
GPHA - Woodland Avenue Health
Center
GPHA -Southeast Health Center
John Bell Health Center
Jonathan Lax Treatment Center
Kennedy Health Systems-Raphael
Meadow Center
Kennedy Health Systems-Voorhees
Kensington Hospital
Mazzoni Center Family &
Community Medicine
PDPH District Health Center # 10
PDPH District Health Center #2
Janet Chen, MD
Daniel Conway, MD
Jill Foster, MD
Roberta Laguerre, MD
Neil Rellosa, MD
Amy Baranoski, MD, MSc
Jeffrey M. Jacobson, MD
Dong Heun Lee, MD
Zsofi Szep, MD, MSCE
Stacey Trooskin, MD, PhD
Christopher Vinnard, MD, MPH
Ani Maitin, CRNP
www.drexelmedicine.org/patientservices/infectious-diseases/ourlocations/
www.fpcn.com
www.fpcn.com
David V. Condoluci, D.O.
Mark J. Fussa, D.O.
www.gsida.org
Dr. Brenda Rogers
Joseph Ondercin, PA
www.gphainc.org
Dr. Luistro Anthony
Josheph Ondercin, PA
www.gphainc.org
Helen Koenig, MD
Joe Garland, MD
Angela Kapalko, MHS, PA-C
www.fight.org
www.fight.org
www.kennedyhealth.org
Dr. Nicolas Ifft
Dr. Robert Winn
Nancy Brisbon, MD
Dr. Sarah Messick
PDPH District Health Center #3
Dr. Stacey Parker-Johnson, DO
Dr. V B. Marshall Jr, DO
Dr. Esther Chernak
PDPH District Health Center #4
Blake Marshall, DO
PDPH District Health Center #5
Dr. Rita Eburuoh
PDPH District Health Center #6
Blake Marshall, DO
111
www.scfchildren.org/dorothymann-center-for-pediatric-andadolescent-hiv-2
www.kennedyhealth.org
215-426-8100
www.mazzonicenter.org/program
s/medical-care
www.phila.gov/health/ambulator
yhealth/hc10.html
www.phila.gov/health/ambulator
yhealth/hc2.html
www.phila.gov/health/ambulator
yhealth/hc3.html
www.phila.gov/health/ambulator
yhealth/hc4.html
www.phila.gov/health/ambulator
yhealth/hc5.html
http://www.phila.gov/health/am
bulatoryhealth/hc6.html
PDPH District Health Center #9
PDPH Strawberry Mansion Health
Center
James Dean, MD
Eileen Donaghy, CRNP
Dr. Millen Gebreselassie
Dr. Tanya Malone
Dr. Helena Kwakwa
Jeanette Skipper-Thomas
Charlotta Swain
Penn Infectious Diseases and Travel
Medicine
Penn Presbyterian Medical CenterInfectious Diseases
PHMC Care Clinic
*Will provided if patient of clinic*
Spectrum Health Services Inc.
Brendan J. Kelly, MD
Jay R. Kostman, MD
Carol A. McLaughlin, MD
Vincent Lo Re, III, MD
Naasha J. Talati, MD
Helena Kwakwa, MD
Roberta Lee Powell, MD
Alvin Kingcade, PA
Katie Huynn, PA
Kheng Lim, MD
Carlotta Lindsay, MD
Daniel Moscow, MD
Temple University Comprehensive
HIV Program
The MacGregor Clinic
Hospital of the University of
Pennsylvania
Thomas Jefferson University
Infectious Diseases
Valerianna K. Amorosa, MD
Katharine J. Bar, MD
Todd Barton, MD
Emily A. Blumberg, MD
Neil O. Fishman, MD
Ian Frank, MD
Phillip A. Green, MD
Robert Gross, MD, MSCE
Janet Hines, MD
Rahul M. Kohli, MD, PhD
Bryan D. Hess, MD
Kathleen Squires, MD
Youth Health Empowerment
Project (YHEP)
www.phila.gov/health/ambulator
yhealth/hc9.html
www.phila.gov/health/ambulator
yhealth/hcStrawberry.html
www.pennmedicine.org/providers/
practice/infectious-diseases-travelmedicine-pennsylvania-hospital
www.pennmedicine.org/infectious
-diseases/
www.phmc.org/site/programs/he
alth-care-centers/375-phmc-careclinic
www.spectrumhs.org/
www.temple.edu/medicine/depar
tments_centers/clinical_departme
nts/medicine_gim_hiv.htm
www.pennmedicine.org/infectiousdiseases
http://hospitals.jefferson.edu/dep
artments-and-services/infectiousdiseases/
www.fight.org
Substance Use Treatment Services
ACT One (Achievement Through Counseling and
Treatment)
www.jevshumanservices.org
112
ACT Two (Achievement Through Counseling and
Treatment)
Al-Anon Info Service of Delaware Valley
Al-Anon Southern Jersey Information
Alcoholics Anonymous, Southeastern Pennsylvania
InterGroup Association (SEPIA)
Asociacion de Puertorriquenos en Marcha
Behavioral Health Special Initiative (BHSI)
Belmont Center for Comprehensive Treatment
Bridge Treatment Program
Bridges Step Down
Center for Family Services
Children's Hospital Of Philadelphia - Cobbs Creek
Children's Hospital Of Philadelphia Adolescent Clinic
Cocaine Anonymous
Community Behavioral Health (CBH)
Community Council for Health Systems
Consortium
Council of Southeast Pennsylvania
Council on Addictive Diseases (COAD)
Crisis Response Center at Einstein-Germantown
Community Center
Crisis Response Center at Friends Hospital
Crisis Response Center at Mercy Hospital
Crisis Response Center at Temple/ Episcopal Hospital
Crozer Keystone Health Systems
Department of Behavioral Health and Intellectual
DisAbility Services
Eagleville Hospital
Family and Community Service of Delaware County
Frankford Avenue Health Center
Gaudenzia, Inc.
Good Shepard Program of St. Johns Hospice
GPHA/AL-ASSIST Behavioral Health Care Center
GPHA-Wilson Park Medical Center
Holcomb Behavioral Health Systems
Kensington Hospital
Kensington Hospital-Erie Clinic
Maria de los Santos Health Center
Maryville, Inc.
Northeast Treatment Center
ODAAT
113
www.jevshumanservices.org
AISDV.org
www.southjerseyal-anon.org/index.html
www.sepennaa.org
www.apmphila.org
www.dbhids.org/behavioral-health-special-initiative
www.einstein.edu/locations/belmont-behavioralhealth/
www.thebridgePhiladelphia.org
www.phmc.org
www.centerffs.org
www.chop.edu
www.chop.edu
www.caphilly.org
www.phila.gov/dbhids
www.cchss.org
www.consortium-inc.org
www.councilsepa.org
www.coadgroup.com
www.eistein.edu
www.friendshospital.com
www.mercyhealth.org/mercyPhiladelphia
www.episcopal.templehealth.org
www.crozer.org
www.dbhids.org
www.eaglevillehospital.org
www.fcsdc.org
www.gphainc.org
www.gaudenzia.org
www.saintjohnshospice.org
www.gphainc.org
www.gphainc.org
www.chimes.org/holcomb/
215-426-8100
215-426-8100
www.dvch.org/locations/maria-de-los-santos-healthcenter
http://maryvillenj.org
http://netcenters.org
http://www.uac.org/partners/one-day-time-odaat
Office of Addiction Services
Penn Behavioral Health
Philadelphia Fight
Prevention Point Philadelphia- Indiana Outreach Site
Prevention Point Philadelphia- North Central
Philadelphia Outreach Site
Prevention Point Philadelphia-Kensington Ave
Prevention Point Philadelphia-North Philadelphia
Outreach Site
Prevention Point Philadelphia-South Philadelphia
Outreach Site
Prevention Point Philadelphia-West Philadelphia
Outreach Site
Ready, Willing and Able
Resources for Human Development
Valley Forge Medical Center and Hospital
www.dbhids.org/office-of-addicitive-services
www.med.upenn.edu/pbh
www.fight.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
http://ppponline.org
www.rwaphiladelphia.org
www.rhd.org
www.vfmc.net
Transportation
AIDS Care Group
Bucks County Transport
Community Transit of Delaware County
Public Health Management Corp - Transportation
Puerto Rican Action Committee
www.aidscaregroup.org
www.bctransport.org
www.ctdelco.org
www.phmc.org
www.pracnj.com/pracservices.html
114
Work Force Capacity Table
The table specifically compares the ratio of the identified area’s concentration of an occupation type to
the national average. This information is conveyed using the location quotient. A location quotient
greater than one indicates the occupation has a higher share of employment than average, and a
location quotient less than one indicates the occupation is less prevalent in the area than average.
Occupations with a location quotient less than one have been highlighted in orange.
115
Occupation Title 82
Community and
Social Service
Occupations
Community
Health Workers
Counselors, All
Other
Dental Assistants
Estimated
Number of
Positions 84
9,950
1.37
39,990
1.50
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
90
0.51
440
0.67
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
290
2.69
200
0.51
1,410
1.19
4,450
1.03
Area 83
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Location
Quotient 85
Occupation Description 86
Community health workers collect data
and discuss health concerns with
members of specific populations and or
are concerned with improving society and
the lives of individuals. These workers
perform a diverse array of duties that may
include counseling individuals with
substance abuse and behavioral problems,
providing social assistance to improve the
social and psychological functioning of
families, and offering spiritual and moral
guidance to members of a faith.
Health educators teach people about
behaviors that promote wellness. They
develop and implement strategies to
improve the health of individuals and
communities. Community health workers
collect data and discuss health concerns
with members of specific populations or
communities.
All counselors not listed separately.
Dental assistants have many tasks,
ranging from providing patient care and
taking x rays to recordkeeping and
scheduling appointments. Their duties
vary by state and by the dentists’ offices
where they work.
Occupation Title- All the information was obtained from the United States Department of Labor, Bureau of Labor Statistics,
http://www.bls.gov/ooh/occupation-finder.htm
83 Area-Metropolitan Statistical Area. For this table two areas were used Camden, NJ Metropolitan Division (15804) and the
Philadelphia, PA Metropolitan Division (37964). Salem County is NOT included in these divisions.
84 Estimated number of positions-Estimated total employment rounded to the nearest 10 (excludes self-employed)
85 Location Quotient-The location quotient is the ratio of the identified area’s concentration of occupational employment as
compared to the national average concentration. A location quotient greater than one indicates the occupation has a higher
share of employment than average, and a location quotient less than one indicates the occupation is less prevalent in the area
than average. The location quotient represents the ratio of an occupation’s share of employment in a given area as compared
to that occupation’s share of employment in the U.S. as a whole.
86 Occupation Description-Based on the descriptions in the Occupation Outlook Handbook, May 2014
82
116
Occupation Title
Dental Hygienists
Estimated
Number of
Positions
790
1.07
2,880
1.06
50
0.61
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
400
1.09
1,470
1.09
120
0.55
1,130
1.38
1,390
1.57
3,100
0.95
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
50
0.70
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Location
Quotient
Dentists, All Other
Specialists
Dentists, General
Dietitians and
Nutritionists
Emergency
Medical
Technicians and
Paramedics
Epidemiologists
117
Occupation Description
Clean teeth and examine oral areas,
head, and neck for signs of oral disease.
May educate patients on oral hygiene,
take and develop x rays, or apply fluoride
or sealants.
Examine, diagnose, and treat diseases,
injuries, and malformations of teeth and
gums. May treat diseases of nerve, pulp,
and other dental tissues affecting oral
hygiene and retention of teeth. May fit
dental appliances or provide preventive
care. Excludes "Prosthodontists" (291024), "Orthodontists" (29-1023), "Oral
and Maxillofacial Surgeons" (29-1022)
and "Dentists, All Other Specialists" (291029).
Dentists diagnose and treat problems
with a patient’s teeth, gums, and related
parts of the mouth. They provide advice
and instruction on taking care of teeth
and gums and on diet choices that affect
oral health.
Dietitians and nutritionists are experts in
food and nutrition. They advise people
on what to eat in order to lead a healthy
lifestyle or achieve a specific healthrelated goal.
Emergency medical technicians (EMTs)
and paramedics care for the sick or
injured in emergency medical settings.
People’s lives often depend on their
quick reaction and competent care. EMTs
and paramedics respond to emergency
calls, performing medical services and
transporting patients to medical facilities.
Epidemiologists are public health
professionals who investigate patterns
and causes of disease and injury in
humans. They seek to reduce the risk and
occurrence of negative health outcomes
through research, community education,
and health policy.
Occupation Title
Family and
General
Practitioners
Health Educators
Healthcare
Practitioners and
Technical
Occupations
Healthcare
Support
Occupations
Healthcare
Support Workers,
All Other
Estimated
Number of
Positions
470
1.00
2,900
1.68
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
100
0.45
1,230
1.56
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
32,580
1.10
120,170
1.11
19,640
1.33
69,620
1.28
**
**
400
0.29
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Location
Quotient
Occupation Description
Physicians and surgeons diagnose and
treat injuries or illnesses. Physicians
examine patients; take medical histories;
prescribe medications; and order,
perform, and interpret diagnostic tests.
They counsel patients on diet, hygiene,
and preventive healthcare. Surgeons
operate on patients to treat injuries, such
as broken bones; diseases, such as
cancerous tumors; and deformities, such
as cleft palates.
Health educators teach people about
behaviors that promote wellness. They
develop and implement strategies to
improve the health of individuals and
communities. Community health workers
collect data and discuss health concerns
with members of specific populations or
communities.
All healthcare practitioners and technical
workers not listed separately.
This major group comprises the all
healthcare support occupations
All healthcare support workers not listed
separately
118
Occupation Title
Home Health
Aides
Internists, General
Lawyers
Licensed Practical
and Licensed
Vocational Nurses
Medical and
Clinical Laboratory
Technicians
Medical and
Health Services
Managers
119
Estimated
Number of
Positions
3,530
1.18
21,670
1.97
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
150
0.82
560
0.84
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
2,390
1.05
13,450
1.62
2,550
0.97
10,670
1.11
370
0.61
4,440
2.01
1,290
1.10
4,660
1.09
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Location
Quotient
Occupation Description
Home health aides help people who are
disabled, chronically ill, or cognitively
impaired. They often help older adults
who need assistance. In some states,
home health aides may be able to give a
client medication or check the client’s
vital signs under the direction of a nurse
or other healthcare practitioner.
Diagnose and provide non-surgical
treatment of diseases and injuries of
internal organ systems. Provide care
mainly for adults who have a wide range
of problems associated with the internal
organs. Include subspecialists, such as
cardiologists and gastroenterologists,
with "All Other Physicians" (29-1069).
Lawyers advise and represent individuals,
businesses, and government agencies on
legal issues and disputes.
Licensed practical nurses (LPNs) and
licensed vocational nurses (LVNs) provide
basic nursing care. They work under the
direction of registered nurses and
doctors.
Perform routine medical laboratory tests
for the diagnosis, treatment, and
prevention of disease. May work under
the supervision of a medical technologist.
Medical and health services managers,
also called healthcare executives or
healthcare administrators, plan, direct,
and coordinate medical and health
services. They might manage an entire
facility or specialize in managing a
specific clinical area or department, or
manage a medical practice for a group of
physicians. Medical and health services
managers must be able to adapt to
changes in healthcare laws, regulations,
and technology.
Occupation Title
Medical Assistants
Medical Records
and Health
Information
Technicians
Medical Scientists,
Except
Epidemiologists
Mental Health
and Substance
Abuse Social
Workers
Mental Health
Counselors
Estimated
Number of
Positions
2,300
1.05
7,170
0.89
290
0.41
2,820
1.11
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
140
0.37
3,250
2.34
460
1.12
3,260
2.16
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
560
1.24
4,260
2.57
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Location
Quotient
Occupation Description
Medical assistants complete
administrative and clinical tasks in the
offices of physicians, podiatrists,
chiropractors, and other health
practitioners. Their duties vary with the
location, specialty, and size of the
practice.
Medical records and health information
technicians, commonly referred to as
health information technicians, organize
and manage health information data.
They ensure its quality, accuracy,
accessibility, and security in both paper
and electronic systems. They use various
classification systems to code and
categorize patient information for
insurance reimbursement purposes, for
databases and registries, and to maintain
patients’ medical and treatment
histories.
Medical scientists conduct research
aimed at improving overall human
health. They often use clinical trials and
other investigative methods to reach
their findings.
Assess and treat individuals with mental,
emotional, or substance abuse problems,
including abuse of alcohol, tobacco,
and/or other drugs. Activities may
include individual and group therapy,
crisis intervention, case management,
client advocacy, prevention, and
education.
Mental health counselors and marriage
and family therapists help people
manage and overcome mental and
emotional disorders and problems with
their family and relationships. They listen
to clients and ask questions, to help the
clients understand their problems and
develop strategies to improve their lives.
120
Occupation Title
Nurse
Practitioners
Nursing Assistants
Obstetricians and
Gynecologists
Opticians,
Dispensing
Optometrists
Pediatricians,
General
121
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Estimated
Number of
Positions
540
1.17
1,510
0.90
7,770
1.45
26,560
1.35
110
1.32
90
0.30
160
0.58
710
0.71
160
1.29
240
0.52
220
1.90
30
0.07
Location
Quotient
Occupation Description
Nurse anesthetists, nurse midwives, and
nurse practitioners, also referred to as
advanced practice registered nurses
(APRNs), provide and coordinate patient
care and they may provide primary and
specialty health care. The scope of
practice varies from state to state.
Nursing assistants and orderlies help
provide basic care for patients in
hospitals and residents of long-term care
facilities, such as nursing homes.
Diagnose, treat, and help prevent
diseases of women, especially those
affecting the reproductive system and
the process of childbirth.
Dispensing opticians help fit eyeglasses
and contact lenses, following
prescriptions from ophthalmologists and
optometrists. They also help customers
decide which eyeglass frames or contact
lenses to buy.
Optometrists examine the eyes and
other parts of the visual system. They
also diagnose, and treat visual problems,
and manage diseases, injuries, and other
disorders of the eyes. They prescribe
eyeglasses or contact lenses as needed.
Physicians who diagnose, treat, and help
prevent children's diseases and injuries.
Occupation Title
Personal Care
Aides
Pharmacists
Pharmacy
Technicians
Phlebotomists
Physical Therapist
Aides
Estimated
Number of
Positions
1,140
0.24
20,670
1.19
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
1,380
1.26
4,300
1.07
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
1,280
0.92
4,790
0.94
420
0.99
1,540
1.00
530
2.88
730
1.08
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Location
Quotient
Occupation Description
Assist the elderly, convalescents, or
persons with disabilities with daily living
activities at the person's home or in a
care facility. Duties performed at a place
of residence may include keeping house
(making beds, doing laundry, washing
dishes) and preparing meals. May
provide assistance at non-residential care
facilities. May advise families, the elderly,
convalescents, and persons with
disabilities regarding such things as
nutrition, cleanliness, and household
activities.
Pharmacists dispense prescription
medications to patients and offer
expertise in the safe use of prescriptions.
They also may provide advice on how to
lead a healthy lifestyle, conduct health
and wellness screenings, provide
immunizations, and oversee the
medications given to patients.
Pharmacy technicians help licensed
pharmacists dispense prescription
medication to customers or health
professionals.
Phlebotomists draw blood for tests,
transfusions, research, or blood
donations. Some explain their work to
patients and provide assistance when
patients have adverse reactions after
their blood is drawn.
Physical therapist assistants (sometimes
called PTAs) and physical therapist aides
work under the direction and supervision
of physical therapists. They help patients
who are recovering from injuries and
illnesses regain movement and manage
pain.
122
Occupation Title
Physical Therapist
Assistants
Physical
Therapists
Physician
Assistants
Physicians and
Surgeons, All
Other
Psychiatric Aides
Psychiatric
Technicians
123
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Estimated
Number of
Positions
140
0.50
1,460
1.38
950
1.26
3,270
1.18
250
0.73
1,600
1.27
2,140
1.83
4,240
0.99
1,140
4.17
750
0.75
70
0.29
Location
Quotient
Occupation Description
Physical therapist assistants (sometimes
called PTAs) and physical therapist aides
work under the direction and supervision
of physical therapists. They help patients
who are recovering from injuries and
illnesses regain movement and manage
pain.
Physical therapists, sometimes called
PTs, help injured or ill people improve
their movement and manage their pain.
These therapists are often an important
part of rehabilitation and treatment of
patients with chronic conditions or
injuries.
Physician assistants, also known as PAs,
practice medicine on a team under the
supervision of physicians and surgeons.
They are formally educated to examine
patients, diagnose injuries and illnesses,
and provide treatment.
All physicians and surgeons not listed
separately.
Psychiatric technicians and aides care for
people who have mental illness and
developmental disabilities. Technicians
typically provide therapeutic care. Aides
help patients in their daily activities and
ensure a safe, clean environment.
Psychiatric technicians and aides care for
people who have mental illness and
developmental disabilities. Technicians
typically provide therapeutic care. Aides
help patients in their daily activities and
ensure a safe, clean environment.
Occupation Title
Psychiatrists
Psychologists, All
Other
Registered Nurses
Rehabilitation
Counselors
Social and
Community
Service Managers
Social and Human
Service Assistants
Social Scientists
and Related
Workers, All
Other
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Estimated
Number of
Positions
80
0.88
450
1.30
160
0.94
11,460
1.14
43,040
1.16
260
0.66
2,820
1.97
510
1.17
2,130
1.33
3,870
2.90
7,460
1.53
80
0.64
130
0.29
Location
Quotient
Occupation Description
Physicians who diagnose, treat, and help
prevent disorders of the mind.
Psychologists study cognitive, emotional,
and social processes and human behavior
by observing, interpreting, and recording
how people relate to one another and
their environments.
Registered nurses (RNs) provide and
coordinate patient care, educate patients
and the public about various health
conditions, and provide advice and
emotional support to patients and their
family members.
Rehabilitation counselors help people
with emotional and physical disabilities
live independently. They work with
clients to overcome or manage the
personal, social, and professional effects
of disabilities on employment or
independent living.
Social and community service managers
coordinate and supervise social service
programs and community organizations.
They direct and lead staff who provide
social services to the public.
Social and human service assistants help
people get through difficult times or get
additional support. They assist other
workers, such as social workers, and they
help clients find benefits or community
services.
All social scientists and related workers
not listed separately.
124
Occupation Title
Social Workers, All
Other
Sociologists
Substance Abuse
and Behavioral
Disorder
Counselors
125
Area
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Burlington,
Camden and
Gloucester Co.
Bucks, Chester,
Delaware,
Montgomery and
Philadelphia Co.
Estimated
Number of
Positions
150
0.66
350
0.41
**
**
410
1.29
2,800
2.39
Location
Quotient
Occupation Description
Social workers help people solve and
cope with problems in their everyday
lives. One group of social workers, clinical
social workers, also diagnose and treat
mental, behavioral, and emotional issues.
Sociologists study society and social
behavior by examining the groups,
cultures, organizations, social
institutions, and processes that people
develop.
Substance abuse and behavioral disorder
counselors advise people who suffer
from alcoholism, drug addiction, eating
disorders, or other behavioral problems.
They provide treatment and support to
help the client recover from addiction or
modify problem behaviors.
Appendix B: Letters of Concurrence
126
127
APPENDIX C: GLOSSARY
This glossary combines definitions of terms found in HRSA’s glossary of terms for the Ryan White
HIV/AIDS Program, the CDC’s glossary of HIV prevention terms as associated with FOA PS11-1113, the
CDC’s glossary of terms as contained in the HIV Planning Guidance, and HRSA and CDC’s list of terms in
their integrated guidance for developing epidemiologic profiles.
A
AIDS Drug Assistance Program (ADAP). Administered by States and authorized under Part B of the Ryan
White Treatment Modernization Act. Provides FDA-approved medications to low-income individuals
with HIV disease who have limited or no coverage from private insurance or Medicaid. ADAP funds may
also be used to purchase insurance for uninsured Ryan White HIV/AIDS Program clients as long as the
insurance costs do not exceed the cost of drugs through ADAP and the drugs available through the
insurance program at least match those offered through ADAP.
AIDS (Acquired Immunodeficiency Syndrome). A disease caused by the human immunodeficiency virus
AIDS Service Organization (ASO). An organization that provides primary medical care and/or support
services to populations infected with and affected by HIV disease.
B
Behavioral data. Information collected from studies that examine human behavior relevant to disease
risk. For instance, relevant behavioral data for HIV risk may include sexual activity, substance use,
condom use, etc.
Behavioral intervention. See “Intervention.”
C
Capacity. Core competencies that substantially contribute to an organization's ability to deliver effective
HIV/AIDS primary medical care and health-related support services. Capacity development activities
should increase access to the HIV/AIDS service system and reduce disparities in care among underserved
PLWH in the EMA.
Capacity building. Activities that strengthen the core competencies of an organization and contribute to
its ability to develop and implement an effective HIV prevention intervention and sustain the
infrastructure and resource base necessary to support and maintain the intervention
CARE Act (Ryan White Comprehensive AIDS Resources Emergency Act). Federal legislation created to
address the unmet health care and service needs of people living with HIV Disease (PLWH) disease and
128
their families. It was enacted in 1990 and reauthorized in 1996 and 2000. Reauthorized in 2006 as the
Ryan White Treatment Modernization Act.
Case. A condition, such as HIV infection (e.g., an HIV case) diagnosed according to a standard case
definition.
Case fatality. The number of deaths among persons with a diagnosis of the disease of interest. Usually
expressed as a rate (number of deaths after disease onset or diagnosis divided by the number of
persons with the disease); measures the effect of the disease on persons with a diagnosis.
Centers for Disease Control and Prevention (CDC). The lead federal agency for protecting the health
and safety of people, providing credible information to enhance health decisions, and promoting health
through strong partnerships. Based in Atlanta, Georgia, this agency of the U.S. Department of Health
and Human Services serves as the national focus for developing and applying disease prevention and
control, environmental health, and health promotion and education activities designed to improve the
health of the people of the United States.
Centers for Medicare and Medicaid Services (CMS). Federal agency within HHS that administers the
Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP).
Collaboration. Working with another person, organization, or group for mutual benefit by exchanging
information, sharing resources, or enhancing the other's capacity, often to achieve a common goal or
purpose.
Community-Based Organization (CBO). An organization that provides services to locally defined
populations, which may or may not include populations infected with or affected by HIV disease.
Community forum or public meeting. A small-group method of collecting information from community
members in which a community meeting is used to provide a directed but highly interactive discussion.
Similar to but less formal than a focus group, it usually includes a larger group; participants are often
self-selected (i.e., not randomly selected to attend).
Community members. 1) consumers/ members of the priority population that are receiving services, or
2) people who are not affiliated with organizations but are infected or affected by HIV and have a
passion to address HIV.
Co-morbidity. A disease or condition, such as mental illness or substance abuse, co-existing with HIV
disease.
Comprehensive planning. The process of determining the organization and delivery of HIV services. This
strategy is used by planning bodies to improve decision-making about services and maintain a
continuum of care for PLWH.
Conflict of interest. Conflict between the private interests and public obligations of a person in an
official position.
129
Confidentiality. The treatment of information that an individual or institution has disclosed in a
relationship of trust, with the expectation that the information will not be divulged to others in ways
that are inconsistent with the individual’s or institution’s understanding when the individual or
institution provided the information. It encompasses access to, and disclosure of, information in
accordance with requirements of state law or official policy. For HIV surveillance data, confidentiality
refers to the protection of private information collected by the HIV surveillance system.
Continuous Quality Improvement (CQI). An ongoing process that involves organization members in
monitoring and evaluating programs to continuously improve service delivery. CQI seeks to prevent
problems and to maximize the quality of care by identifying opportunities for improvement.
Continuum of care. An approach that helps communities plan for and provide a full range of emergency
and long-term service resources to address the various needs of PLWHA.
Coordination. Aligning processes, services, or systems, to achieve increased efficiencies, benefits, or
improved outcomes. Examples of coordination may include sharing information, such as progress
reports, with state and local health departments or structuring prevention delivery systems to reduce
duplication of effort
Core services. Grantee expenditures are limited to core medical services, support services, and
administrative expenses. See Core Services and Support Services, which are also listed in the Ryan White
legislation as follows: Part A (2604(c), Part B (2612(b), and Part C (2651(c).
Cost-effectiveness. The relative costs and effectiveness of proposed strategies and interventions, either
demonstrated or probable
Counseling and testing. A process through which an individual receives information about HIV
transmission and prevention, information about HIV tests and the meaning of tests results, HIV
prevention counseling to reduce their risk for transmitting or acquiring HIV, and is provided testing to
detect the presence of HIV antibodies.
Cultural competence. The knowledge, understanding, and skills to work effectively with individuals from
differing cultural backgrounds.
Culturally appropriate. Conforming to a culture's acceptable expressions and standards of behavior and
thoughts. Interventions and educational materials are more likely to be culturally appropriate when
representatives of the intended target audience are involved in planning, developing, and pilot testing
them.
Cumulative cases. The total number of cases of a disease reported or diagnosed during a specified time
regardless of current vital status. Cumulative cases therefore include cases in persons who have already
died.
D
130
Demographics. Characteristics of human populations such as age, race, ethnicity, sex used to classify
them for statistical purposes.
Diversity. Individual differences along the dimensions of race, ethnicity, gender, sexual orientation,
socioeconomic status, age, physical abilities, religious beliefs, political beliefs, health or disease status,
or other ideologies. The concept of diversity encompasses acceptance, respect, and understanding that
each individual is unique.
E
Early Intervention Services (EIS). Activities designed to identify individuals who are HIV-positive and get
them into care as quickly as possible. As funded through Parts A and B of the Ryan White HIV/AIDS
Program, includes outreach, counseling and testing, information and referral services. Under Part C Ryan
White HIV/AIDS Program, also includes comprehensive primary medical care for individuals living with
HIV/AIDS.
Effective. Demonstrating the desired effect when widely used in practice or under real-world conditions
that are considerably less rigorous and controlled than environments testing efficacy but that are still
designed to ensure the desired effect can be attributed to the intervention in question.
Eligible Metropolitan Area (EMA). Geographic areas highly-impacted by HIV/AIDS that are eligible to
receive Ryan White HIV/AIDS Program Part A funds to be an eligible EMA, an area must have reported
more than 2,000 AIDS cases in the most recent 5 years and have a population of at least 50,000.
Engagement process. A process used to identify strategies for increasing coordination between HIV
programs of the state, jurisdiction, and tribal communities for the purpose of applying a collective vision
for the benefit of the overall jurisdiction. Steps for engagement should include determining the activities
of the Jurisdictional HIV Prevention Plan and whom to engage, developing engagement and retention
strategies for previous partners, developing engagement strategies for new partnering agencies,
prioritizing engagement activities, creating an implementation plan, monitoring progress, and
maintaining the partner relationships.
Epidemic. The rapid spread, growth, or occurrence of cases of an illness, health-related behavior, or
other health-related events in a community or region in excess of normal expectation
Epidemiological profile. A document that describes the HIV/AIDS epidemic within various populations
and identifies characteristics of both HIV-infected and HIV-negative persons in defined geographic areas.
It is composed of information gathered to describe the effect of HIV/AIDS on an area in terms of
sociodemographic, geographic, behavioral, and clinical characteristics. The epidemiological profile 55
serves as the scientific basis of the identification and prioritization of HIV prevention and care needs in
any given jurisdiction.
Epidemiology. The study of the causes, spread, control, and prevention of disease in human beings.
131
Estimate. In situations in which precise data are not available, an estimate may be made on the basis of
available data and an understanding of how the data can be generalized to larger populations. In some
instances, national or state data may be statistically adjusted to estimate local conditions. Good
estimates are accompanied by statistical estimates of error (a confidence interval), which describe the
limitations of the estimate.
Evidence-based. Behavioral, social, and structural interventions relevant to HIV risk reduction that has
been tested using a methodologically rigorous design, and have been shown to be effective in a research
setting. These evidence (or science-based interventions) have been evaluated using behavioral or health
outcomes; have been compared to a control/comparison group(s) (or pre-post data without a
comparison group if a policy study); had no apparent bias when assigning persons to intervention or
control groups or were adjusted for any apparent assignment bias; and, produced significantly greater
positive results when compared to the control/comparison group(s), while not producing adverse
consequences.
Exposure category. In describing HIV/AIDS cases, same as transmission categories; how an individual
may have been exposed to HIV, such as injecting drug use, male-to-male sexual contact, and
heterosexual contact.
Ethnicity. The cultural characteristics that connect a particular group or groups of people to each other,
such as people of Hispanic or Latino origin
F
Food and Drug Administration (FDA). Federal agency within HHS responsible for ensuring the safety and
effectiveness of drugs, biologics, vaccines, and medical devices used (among others) in the diagnosis,
treatment, and prevention of HIV infection, AIDS, and AIDS-related opportunistic infections. The FDA
also works with the blood banking industry to safeguard the nation's blood supply.
Funding Opportunity Announcement (FOA). A CDC announcement informing the public of the
availability of funds to develop and implement programs that meet a public health goal; including a
solicitation of applications for funding. The FOA describes required activities and asks the applicants to
describe how they will carry out the required activities.
G
Grantee. The recipient of Ryan White HIV/AIDS Program funds responsible for administering the award.
H
Health centers. Community-based and patient-directed organizations that serve populations with
limited access to health care. These include low income populations, the uninsured, those with limited
132
English proficiency, migrant and seasonal farmworkers, individuals and families experiencing
homelessness, and those living in public housing.
Health disparity. A particular type of health difference that is closely linked with social or economic
disadvantage based on their racial or ethnic group, religion, socioeconomic status, gender, mental
health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other
characteristics historically linked to discrimination or exclusion
Health Education/Risk Reduction (HE/RR). Organized efforts to reach people at increased risk of
becoming HIV-infected or, if already infected, of transmitting the virus to others. The goal is to reduce
the spread of infection. Activities range from individual HIV prevention counseling to broad, communitybased interventions.
Health equity. A desirable goal that entails special efforts to improve the health of those who have
experienced social or economic disadvantage. It requires continuous efforts focused on elimination of
health disparities, including disparities in health and in the living and working conditions that influence
health, and continuous efforts to maintain a desired state of equity after particular health disparities are
eliminated.
Health Insurance Continuity Program (HICP). A program primarily under Part B of the Ryan White
HIV/AIDS Program that makes premium payments, co-payments, deductibles, and/or risk pool payments
on behalf of a client to purchase/maintain health insurance coverage.
Health Resources and Services Administration (HRSA). The agency of the U.S. Department of Health
and Human Services that administers various primary care programs for the medically underserved,
including the Ryan White HIV/AIDS Program.
High-risk individual. Someone who has recently engaged in HIV risk behaviors where there is a high
probability of becoming infected with HIV (see HIV risk behaviors).
Highly Active Antiretroviral Therapy (HAART). HIV treatment using multiple antiretroviral drugs to
reduce viral load to undetectable levels and maintain/increase CD4 levels.
HIV/AIDS Bureau (HAB). The bureau within the Health Resources and Services Administration (HRSA) of
the U.S. Department of Health and Human Services (HHS) that is responsible for administering the Ryan
White HIV/AIDS Program.
HIV disease. Any signs, symptoms, or other adverse health effects due to the human immunodeficiency
virus.
HIV infection, stage unknown. No reported information on AIDS-defining conditions and no information
available on CD4 count or percentage.
HIV medical care/evaluation/treatment. Medical services that address HIV infection including
evaluation of immune system function and screening, treatment, and prevention of opportunistic
infection.
133
HIV planning group (HPG). The official HIV planning body that follows the HIV Planning Guidance to
inform the development or update of the health department’s jurisdictional HIV Prevention Plan that
will contribute to the reduction of HIV infection in the jurisdiction.
HIV prevention counseling. An interactive process between client and counselor aimed at reducing risky
sex and drug-injection behaviors related to HIV acquisition or transmission.
HIV risk behaviors. Persons likely to be at high risk for HIV include persons who have: had unprotected
anal or vaginal sex with a person living with HIV, injected drugs with non-sterile, shared drug-injection
equipment, had unprotected anal or vaginal sex in exchange for money or drugs, had unprotected anal
or vaginal sex with more than one sex partner since their most recent negative HIV test, been diagnosed
with a sexually transmitted disease (STD), and persons who have had unprotected anal or vaginal sex
with anyone who had any of these risks.
Housing Opportunities for People With AIDS (HOPWA). A program administered by the U.S.
Department of Housing and Urban Development (HUD) that provides funding to support housing for
PLWHA and their families.
HUD (U.S. Department of Housing and Urban Development). The Federal agency responsible for
administering community development, affordable housing, and other programs including Housing
Opportunities for People with AIDS (HOPWA).
I
Incidence. The number of new cases of a disease that occur during a specified time period.
Inclusion. Meaningful involvement of members in the process with an active role in making decisions.
An inclusive process assures that the views, perspectives, and needs of affected communities, care
providers, and key partners are actively included.
Injection Drug User (IDU). Someone who uses a needle to inject drugs into his or her body.
Intervention. A specific activity (or set of related activities) intended to reduce the risk of HIV
transmission or acquisition. Interventions may be either biomedical or behavioral and have distinct
process and outcome objectives and protocols outlining the steps for implementation.
J
Jurisdiction. An area or region that is the responsibility of a particular governmental agency. This term
usually refers to an area where a state or local health department monitors HIV prevention activities.
(For example, Jonestown is within the jurisdiction of the Jones County Health Department.)
134
Jurisdictional HIV Prevention Plan. The health department, in collaboration with the HPG, previously
developed a Jurisdictional HIV Prevention Plan. This plan has been replaced by the Integrated HIV Care
and Prevention Plan, which incorporates plans for both the care and prevention systems.
L
Linkage. Actively assisting clients with accessing needed services through a time-limited professional
relationship. The active assistance typically lasts a few days to a few weeks and includes a follow-up
component to assess whether linkage has occurred. Linkage services can include: assessment,
supportive counseling, education, advocacy, and accompanying clients to initial appointments.
Local Health Department. A health department and/or health department facility responsible for
providing and/or supporting the provision of direct client services in a county or city.
M
Men who have Sex with Men (MSM). Men who report sexual contact with other men (that is,
homosexual contact) and men who report sexual contact with both men and women (that is, bisexual
contact), whether or not they identify as “gay”.
Metro Statistical Area (MSA). A core area containing a large population nucleus together with adjacent
communities having a high degree of economic and social integration with that core.
Met/Unmet need. A met need is a need within a specific target population for HIV prevention and or
care services that is currently being addressed through existing resources. These resources are available
to, appropriate for, and accessible to that population. For example, a project area with an organization
for African American gay, bisexual, lesbian, and transgender individuals may meet the HIV/AIDS
education needs of African American men who have sex with men through its outreach, public
information, and group counseling efforts. An unmet need is a requirement for HIV prevention and or
care services within a specific target population that is not being addressed through existing HIV
prevention services and activities—either because no services are available or because available services
are either inappropriate for, or inaccessible to, the target population. For example, a project area lacking
Spanish-language HIV counseling and testing services will not meet the needs of Latinos with limited
English proficiency.
Minority AIDS Initiative (MAI). A national HHS initiative that provides special resources to reduce the
spread of HIV/AIDS and improve health outcomes for people living with HIV/AIDS within communities of
color. Enacted to address the disproportionate impact of the disease in such communities. Formerly
referred to as the Congressional Black Caucus Initiative because of that body's leadership in its
development.
Morbidity. The presence of illness in the population.
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Mortality. The total number of persons who have died of the disease of interest. Usually expressed as a
rate, mortality (total number of deaths over the total population) measures the effect of the disease on
the population as a whole.
MSM/IDU. Men who report both sexual contact with other men and injection drug use as risk factors for
HIV infection.
N
National HIV/AIDS Strategy (NHAS). A comprehensive plan focused on: reducing HIV incidence,
increasing access to care and optimizing health outcomes, and reducing HIV related health disparities.
Navigation services. A process of service delivery to help a person obtain timely, essential and
appropriate HIV-related medical and social services to optimize his or her health and prevent HIV
transmission and acquisition. Navigation includes linking persons to health care systems, assisting with
health insurance and transportation, identifying and reducing barriers to care and tailoring health
education to the client to influence his or her health-related attitudes and behaviors.
Needs assessment. A process of collecting information about the needs of PLWHA (both those receiving
care and those not in care), identifying current resources (Ryan White HIV/AIDS Program and other)
available to meet those needs, and determining what gaps in care exist.
No identified risk (NIR). Cases in which epidemiologic follow-up has been conducted, sources of data
have been reviewed—which may include an interview with the patient or provider—and no mode of
exposure has been identified. Any case that continues to have no reported risk 12 or more months after
the report date is considered NIR.
O
Office of Management and Budget (OMB). The office within the executive branch of the Federal
government that prepares the President's annual budget, develops the Federal government's fiscal
program, oversees administration of the budget, and reviews government regulations.
Opportunistic Infection (OI) or Opportunistic Condition. An infection or cancer that occurs in persons
with weak immune systems due to HIV, cancer, or immunosuppressive drugs such as corticosteroids or
chemotherapy. Examples include Kaposi's Sarcoma (KS); Pneumocystis jiroveci pneumonia (PCP);
cryptosporidiosis; histoplasmosis; toxoplasmosis; other parasitic, viral, and fungal infections; and some
types of cancers.
Outcome evaluation. Collection of data about outcomes before and after the intervention for clients as
well as a similar group that did not participate in the intervention being evaluated (i.e., control group);
determines if the intervention resulted in the expected outcomes.
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Outcome monitoring. Involves the routine documentation and review of program-associated outcomes
(e.g., individual-level knowledge, attitudes and behaviors or access to services; service delivery;
community or structural factors) in order to determine the extent to which program goals and
objectives are being met.
Outreach. A process of engaging face-to-face with high-risk individuals in their own neighborhoods or
venues where they typically congregate to provide HIV testing or referrals for testing. Outreach is often
conducted by per or paraprofessional educators.
P
Parity. The ability of HIV planning group members to equally participate and carry out planning tasks or
duties in the planning process. To achieve parity, representatives should be provided with opportunities
for orientation and skills-building to participate in the planning process and have an equal voice in voting
and other decision-making activities.
Partner Services (PS). A systematic approach to notifying sex and needle-sharing partners of HIVpositive persons of their possible exposure to HIV so they can be offered HIV testing and learn their
status, or, if already infected, prevent transmission to others. PS helps partners gain earlier access to
individualized counseling, HIV testing, medical evaluation, treatment, and other prevention services.
Part A. The part of the Ryan White HIV/AIDS Program (formerly, Title I) that provides emergency
assistance to localities (EMAs) disproportionately affected by the HIV/AIDS epidemic.
Part B. The part of the Ryan White HIV/AIDS Program (formerly, Title II) that provides funds to States
and territories for primary health care (including HIV treatments through the AIDS Drug Assistance
Program, ADAP) and support services that enhance access to care to PLWHA and their families.
Part C. The part of the Ryan White HIV/AIDS Program (formerly, Title III) that supports outpatient
primary medical care and early intervention services to PLWHA through grants to public and private
non-profit organizations. Part C also funds capacity development and planning grants to prepare
programs to provide EIS services.
Part D. The part of the Ryan White HIV/AIDS Program (formerly, Title IV) that supports coordinated
services and access to research for children, youth, and women with HIV disease and their families.
Part F (AETC) (AIDS Education and Training Center). Regional centers providing education and training
for primary care professionals and other AIDS-related personnel. Part F (AETC)s are authorized under
Part F of the Ryan White HIV/AIDS Program and administered by the HRSA HIV/AIDS Bureau's Division of
Training and Technical Assistance (DTTA).
Part F (Community Based Dental Partnership Program). The program within the HRSA HIV/AIDS
Bureau's Division of Community Based Programs that delivers HIV/AIDS dental care while
simultaneously training dental professionals in these areas in order to expand community capacity to
deliver HIV oral health care.
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Part F (HIV/AIDS Dental Reimbursement Program). The program within the HRSA HIV/AIDS Bureau's
Division of Community Based Programs that assists with uncompensated costs incurred in providing oral
health treatment to PLWHA.
Part F (SPNS) (Special Projects of National Significance). A health services demonstration, research, and
evaluation program funded under Part F of the Ryan White HIV/AIDS Program to identify innovative
models of HIV care. Part F (SPNS) projects are awarded competitively.
Performance indicator. A program performance indicator (or measure) is a piece of information, fact, or
statistic that provides insight into the performance of a program. It helps us understand progress toward
specified outcomes, a jurisdiction's capacity to carry out its work, the activities it performs in carrying
out its work, and the HIV prevention outcomes it is trying to achieve.
Planning Council (PC). A planning body appointed or established by the Chief Elected Official of an EMA
whose basic function is to assess needs, establish a plan for the delivery of HIV care in the EMA, and
establish priorities for the use of Ryan White HIV/AIDS Program Part A funds.
Planning group. Refers to CDC- and HRSA-sponsored groups, such as HIV prevention planning groups
(HPGs) and Ryan White HIV/AIDS planning councils and consortia.
Planning process. Steps taken and methods used to collect information, analyze and interpret it, set
priorities, and prepare a plan for rational decision making.
PLWHA. A person or persons living with HIV or AIDS.
Prevalence. The total number of persons in a defined population living with a specific disease or
condition at a given time (compared to incidence, which is the number of new cases).
Prevalence rate. The proportion of a population living at a given time with a condition or disease
(compared to the incidence rate, which refers to new cases).
Prevention activity. Activity that focuses on behavioral interventions, structural interventions, capacity
building, or information gathering.
Prevention program. An organized effort to design and implement one or more interventions to achieve
a set of predetermined goals, for example, to increase condom use with non-steady partners.
Prevention services. Interventions, strategies, programs, and structures designed to change behavior
that may lead to HIV infection or other diseases. Examples of HIV prevention services include street
outreach, educational sessions, condom distribution, and mentoring and counseling programs.
Priority population. A population identified through the epidemiologic profile and community services
assessment that requires prevention efforts due to high rates of HIV infection and the presence of risky
behavior.
Priority setting. The process used to establish priorities among service categories, to ensure consistency
with locally identified needs, and to address how best to meet each priority.
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Probability sampling. A sampling technique that relies upon random selection to select persons from a
defined population; all persons have a known chance of selection. Types of probability samples include
simple random sample, systematic random sample, and stratified sample.
Process monitoring. The routine documentation and review of program activities, populations served,
and resources used in order to improve the program.
Process objectives. Key program activities or tasks required to achieving outcome(s), or the steps
initiated or required to realize a desired result.
Prophylaxis. Treatment to prevent the onset of a particular disease (primary prophylaxis) or recurrence
of symptoms in an existing infection that has previously been brought under control (secondary
prophylaxis).
Proportion. A portion of a population or a data set, usually expressed as a fraction or a percentage of
the population or the data set.
PWID. Person (or people) who inject(s) drugs.
Q
Qualitative data. Non-numeric data, including information from sources such as narrative behavior
studies, focus group interviews, open-ended interviews, direct observations, ethnographic studies, and
documents. Findings from these sources are usually described in terms of underlying meanings,
common themes, and patterns of relationships rather than numeric or statistical analysis. Qualitative
data often complement and help explain quantitative data.
Quality. The degree to which a health or social service meets or exceeds established professional
standards and user expectations.
Quality of life. A subjective measure of the degree to which persons affected by a specific disease,
injury, or form of treatment perceive themselves to be able to function physically, emotionally, and
socially. Quality of life is useful for the planning of health services.
Quality Assurance (QA). The process of identifying problems in service delivery, designing activities to
overcome these problems, and following up to ensure that no new problems have developed and that
corrective actions have been effective. The emphasis is on meeting minimum standards of care.
Quality Improvement (QI). Also called Continuous Quality Improvement (CQI). An ongoing process of
monitoring and evaluating activities and outcomes in order to continuously improve service delivery.
CQI seeks to prevent problems and to maximize the quality of care.
Quantitative data. Numeric information -- such as numbers, rates, and percentages -- representing
counts or measurements suitable for statistical analysis.
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R
Race. A client's self-reported classification of the biological heritage with which they most closely
identify. Standard OMB race codes are applied.
Rate. A measure of the frequency of an event compared with the number of persons at risk for the
event. When rates are being calculated, it is usual for the denominator to be the general population
rather than the population potentially exposed to HIV infection by various high-risk behaviors. The size
of the general population is known from data from the U.S Census Bureau, whereas the size of a
population at high risk is usually not known. For ease of comparison, the multiplier (100,000) is used to
convert the resulting fraction to number of cases per 100,000 population. Although arbitrary, the choice
of 100,000 is standard practice.
Raw data. Data that are in their original form (i.e., not coded or analyzed).
Recruitment. The process by which individuals are identified and invited to become participants in an
intervention or other HIV prevention service, such as counseling, testing, and referral.
Referral. Directing clients to a service in-person or through telephone, written or other form of
communication, and is generally a one-time event. Referral may be made formally from one clinical
provider to another, within a case management system by professional case managers, informally
through support staff, or as part of an outreach services program.
Referral follow-up. The method that will be used to verify that the client accessed the services to which
he or she was referred. Referral Outcome: The current status of the referral based on activities to verify
that the service was accessed.
Reflectiveness. The extent to which the demographics of the planning body's membership look like the
demographics of the epidemic in the service area.
Reliability. The consistency of a measure or question in obtaining very similar or identical results when
used repeatedly; for example, if you repeated a blood test three times on the same blood sample, it
would be reliable if it generated the same results each time.
Reporting delay. Reporting delays (time between diagnosis or death and the reporting of diagnosis or
death to state/local surveillance program) may differ among demographic and geographic categories;
for some, delays in reporting have been as long as several years. representative. A sample that is similar
to the population from which it is drawn and thus can be used to draw conclusions about the
population.
Representative. Term used to indicate that a sample is similar to the population from which it was
drawn, and therefore can be used to make inferences about that population.
Request for Proposals (RFP). An open and competitive process for selecting providers of services
(sometimes called RFA or Request for Application).
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Resource allocation. The Part A planning council responsibility to assign Ryan White HIV/AIDS Program
amounts or percentages to established priorities across specific service categories, geographic areas,
populations, or subpopulations.
Results-oriented. Developing strategies/activities that will move the group towards accomplishing the
objectives set forth in guidance or FOA. A feedback loop or a review process of the strategies/activities
should be completed to ensure the desired results were accomplished.
Risk behaviors. Behaviors that can directly expose individuals to HIV or transmit HIV, if virus is present
(e.g., unprotected sex, sharing unclean needles). Risk behaviors are actual behaviors in which HIV can be
transmitted. Risk behaviors are behaviors in which a single instance of the behavior can result in a
transmission.
Risk factors. Factors based on observations of behaviors and contexts in which HIV is likely to be
transmitted (e.g., lifetime number of sex partners, crack use, environmental factors like membership in a
demographic group highly impacted by HIV, using old expired-date condoms, internet use, etc.).
Influencing factors of behavioral risk refers to associations with risk or risk correlates and risk contexts,
not behavioral determinants.
Ryan White HIV/AIDS Program. The primary federal legislation created to address the needs for health
and support services among persons living with HIV and their families in the United States; enacted in
1990 and reauthorized in 1996, 2000, 2006, and 2009.
Ryan White HIV/AIDS Program Services Report (RSR). Data collection and reporting system for
reporting information on programs and clients served (Client Level Data).
Ryan White HIV/AIDS Act of 2009 (Ryan White HIV/AIDS Program). Enacted in 2009, this legislation
reauthorized the Ryan White Program, formerly called the Ryan White CARE Act and the Ryan White
HIV/AIDS Treatment Modernization Act of 2006.
S
Sample. A group of people selected from a total population with the expectation that studying this
group will provide important information about the total population.
Scalable. Interventions or combinations of interventions that can reach a significant portion of those in
need, in a cost-efficient manner, and demonstrate population-level impact.
Statewide Coordinated Statement of Need (SCSN). A written statement of need for the entire State
developed through a process designed to collaboratively identify significant HIV issues and maximize
Ryan White HIV/AIDS Program coordination. The SCSN process is convened by the Part B grantee, with
equal responsibility and input by all programs.
Science-based. See “Evidence-based.”
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Section 340B Drug Discount Program. A program administered by the HRSA's Bureau of Primary Care,
Office of Pharmacy Affairs established by Section 340B of the Veteran's Health Care Act of 1992, which
limits the cost of drugs to Federal purchasers and to certain grantees of Federal agencies.
Seroconversion. The development of detectable antibodies to HIV in the blood as a result of infection. It
normally takes several weeks to several months for antibodies to the virus to develop after HIV
transmission. When antibodies to HIV appear in the blood, a person will test positive in the standard
ELISA test for HIV.
Service gaps. All the service needs of all PLWH except for the need for primary health care for
individuals who know their status but are not in care. Service gaps include additional need for primary
health care for those already receiving primary medical care ("in care").
Sexually Transmitted Disease (STD). Social determinants: are the economic and social conditions that
influence the health of individuals, communities and jurisdictions and include conditions for early
childhood development; education, employment, and work; food security, health services, housing,
income, and social exclusion.
Social network. A social network is a map of the relationships between individuals, indicating the ways
in which they are connected through various social familiarities ranging from casual acquaintance to
close familial bonds.
Social networking. A recruitment strategy in which a chain of referrals is based on high risk individuals
using their personal influence to enlist their peers they believe to be high risk.
Sociodemographic factors. Background information about the population of interest (e.g., age, sex,
race, educational status, income, geographic location). These factors are often thought of as explanatory
because they help us to make sense of the results of our analyses.
Socioeconomic status (SES). A description of a person’s societal status using factors or measurements
such as income levels, relationship to the national poverty line, educational achievement, neighborhood
of residence, or home ownership.
Special Projects of National Significance (SPNS). See “Part F”.
Stakeholder. A person or representative who has personal or professional experience, skills, resources,
or expertise in HIV.
Substance Abuse and Mental Health Services Administration (SAMHSA). Federal agency within HHS
that administers programs in substance abuse and mental health.
Substance abuse services. Services for the treatment and prevention of drug or alcohol use.
Support services. Grantee expenditures are limited to core medical services, support services, and
administrative expenses. See Core Services and Support Services, which are also listed in the Ryan White
legislation as follows: Part A (2604(c), Part B (2612(b), and Part C (2651(c).cases).
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Surveillance. An ongoing, systematic process of collecting, analyzing and using data on specific health
conditions and diseases (e.g., Centers for Disease Control and Prevention surveillance system for AIDS
cases).
Syndemics. Two or more afflictions, interacting synergistically, contributing to excess burden of disease
in a population (e.g. STD, viral hepatitis, and substance use). Related concepts include linked 59
epidemics, interacting epidemics, connected epidemics, co-occurring epidemics, comorbidities, and
clusters of health-related crises.
T
Target population. A population to be reached through some action or intervention; may refer to
groups with specific demographic or geographic characteristics.
Technical Assistance (TA). The delivery of practical program and technical support. TA is to assist
grantees, planning bodies, and affected communities in designing, implementing, and evaluating service
delivery systems.
Transgender - Female to Male (FTM). An individual whose physical or birth sex is female but whose
gender expression and/or gender identity is male.
Transgender - Male to Female (MTF). An individual whose physical or birth sex is male but whose
gender expression and/or gender identity is female.
Transmission category. A grouping of disease exposure and infection routes; in relation to HIV disease,
exposure groupings include, for example, men who have sex with men, injection drug use, heterosexual
contact, and perinatal transmission.
Trauma. An emotional response to a terrible event like an accident, assault or natural disaster.
Immediately after the event, shock and denial are typical. Longer term reactions may include emotional,
psychological and physical symptoms.
Trauma-informed. A program, organization, or system that is trauma-informed:
•
•
•
•
Realizes the widespread impact of trauma and understands potential paths for recovery;
Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with
the system;
Responds by fully integrating knowledge about trauma into policies, procedures, and practices;
and
Seeks to actively resist re-traumatization.
Trend. A long-term movement or change in frequency, usually upward or downward; may be presented
as a line graph.
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U
Unmet need. The unmet need for primary health services among individuals who know their HIV status
but are not receiving primary health care.
V
Viral load. In relation to HIV, the quantity of HIV RNA in the blood. Viral load is used as a predictor of
disease progression. Viral load test results are expressed as the number of copies per milliliter of blood
plasma.
Viral suppression. When antiretroviral therapy (ART) reduces a person's viral load (HIV RNA) to an
undetectable level. Viral suppression does not mean a person is cured; HIV still remains in the body. An
undetectable viral load means that there is only a very small chance of transmission to drug using or
sexual partners.
Y
Year of diagnosis. The year in which a diagnosis of HIV infection was made.
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